Tina Bolduc
Individual provider Active NPI Registered Nurse · Willmar, MS
NPI 1821781881 · NPPES record last updated May 26, 2023
Key facts
- NPI
- 1821781881
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Registered Nurse 163W00000X
- License
- 2351566 (MN)
- Practice address
- 301 Becker Ave SW
Willmar, MS 56271 - Phone
- (320) 251-2700
- NPI assigned
- May 26, 2023
- Sex
- Female
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2351566 | MN | MD | Registered Nurse |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Registered Nurse | 163W00000X | 2351566 | MN | Yes |
Addresses
Primary practice location
301 Becker Ave SW
Willmar, MS 56271
Mailing address
301 Becker Ave SW
Willmar, MN 56201-3302
Phone (320) 251-2700
Other names
- Tina Kohout
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on May 26, 2023. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.