Basic Information
| Provider Information | |||||||||
| NPI: | 1821463167 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BOELTER | ||||||||
| FirstName: | CHRISTOPHER | ||||||||
| MiddleName: | BRICE | ||||||||
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| Credential: | MSN, ACNP-BC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 63362 | ||||||||
| Address2: | |||||||||
| City: | CHARLOTTE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 282633362 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9196204700 | ||||||||
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| Practice Location | |||||||||
| Address1: | 10 DUKE MEDICINE CIR | ||||||||
| Address2: | |||||||||
| City: | DURHAM | ||||||||
| State: | NC | ||||||||
| PostalCode: | 277101000 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9193858341 | ||||||||
| FaxNumber: | 9193851477 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/12/2015 | ||||||||
| LastUpdateDate: | 12/02/2016 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LA2100X | 5008241 | NC | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Acute Care | 363L00000X | 5008241 | NC | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner |
No ID Information.