Justin Bolin

Primary specialty

Diabetes Educator Registered NurseTaxonomy code 163WD0400X

License

2015024051 Issued in MO

Practice address

615 S New Ballas Rd
Saint Louis, MO 63141-8221

Phone

(314) 251-7921

Fax

(314) 251-4815

NPI assigned

May 2, 2018

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1525219200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1525219200000",
    "number": "1225527633",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "615 S NEW BALLAS RD",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631418221",
            "telephone_number": "314-251-7921",
            "fax_number": "314-251-4815"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "615 S NEW BALLAS RD",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631418221",
            "telephone_number": "314-251-7921",
            "fax_number": "314-251-4815"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BOLIN",
        "first_name": "JUSTIN",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2018-05-02",
        "last_updated": "2018-05-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163WD0400X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, Diabetes Educator",
            "state": "MO",
            "license": "2015024051",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MISSOURI STATE BOARD OF NURSING",
            "identifier": "2015024051",
            "state": "MO"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NATIONAL CERTIFICATION BOARD FOR DIABETES EDUCATORS",
            "identifier": "21800005",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Shawn C Boles, MA, LPC
• Mary Bolesta Brill
• Edward Stephen Bolesta, MD
• Michael Joseph Bolger, M.D.
• Karen E Bolhuis, MSN FNP
• Kathryn E Bolin, LCSW
• Emily Anne Bollinger, PNP
• Libbi Louise Bollinger, MS, RD
• Rebecca M Bollinger, OTD, OTR/L
• Suzanne Gielow Bollmeier, PHARM.D.

• Diabetes Educator Registered Nurse in Saint Louis, MO
• Providers in Saint Louis, MO by specialty
• Diabetes Educator Registered Nurse in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 2, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.