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KIRSTEN TORI BOLSTAD PA

>> Physician Assistant >> Physician Assistants & Advanced Practice Nursing Providers

Registrant NPI Number: 1407402266

Individual Registrant:
 KIRSTEN TORI BOLSTAD PA
Gender: F
Not Sole Proprietor

Location and contact information for practice:
1012 BELMONT AVE # 81050  LA JUNTA, CO 81050-2101 US
Tel: 719-383-5900  Fax: --

Contact information for business:
1012 BELMONT AVE  LA JUNTA, CO 81050-2101 US
Tel: 608-606-2547  Fax: --

Registration Information:
NPI: 1407402266
Entity Type: Individual

Specialty information:

PrimaryCodeCategory/DescriptionStateLicense Number
Y363A00000XPhysician Assistants & Advanced Practice Nursing Providers
Physician Assistant
COPA.0005890

Legacy codes, insurance codes and state license numbers:

IssuerNumberStateType




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