Provider Demographics
NPI:1982638441
Name:BOLTON, JUDITH ANN (CRNA)
Entity type:Individual
Prefix:
First Name:JUDITH
Middle Name:ANN
Last Name:BOLTON
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:JUDITH
Other - Middle Name:ANN
Other - Last Name:NAVICKAS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNA
Mailing Address - Street 1:2941 W 118TH TER
Mailing Address - Street 2:
Mailing Address - City:LEAWOOD
Mailing Address - State:KS
Mailing Address - Zip Code:66211-3047
Mailing Address - Country:US
Mailing Address - Phone:913-661-9191
Mailing Address - Fax:
Practice Address - Street 1:2941 W 118TH TER
Practice Address - Street 2:
Practice Address - City:LEAWOOD
Practice Address - State:KS
Practice Address - Zip Code:66211-3047
Practice Address - Country:US
Practice Address - Phone:913-661-9191
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-10
Last Update Date:2008-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO091562367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO013B434Medicare PIN