Crystal Anne Bolos, FNP-BC

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

2021100905 Issued in MI

Practice address

6300 22 Mile Rd Ste 2
Shelby Township, MI 48317-2106

Phone

(586) 726-9860

NPI assigned

Jan 26, 2022

Last updated

Jan 26, 2022By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Michigan Integrative Health Center PC

  • Multi-Specialty Clinic/Center
  • Shelby TWP, MI
  • NPI 1922630490
  NPD

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

{
    "created_epoch": "1643155200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1643155200000",
    "number": "1891447298",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11800 E 12 MILE RD",
            "city": "WARREN",
            "state": "MI",
            "postal_code": "480933472",
            "telephone_number": "586-573-5111"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6300 22 MILE RD STE 2",
            "city": "SHELBY TOWNSHIP",
            "state": "MI",
            "postal_code": "483172106",
            "telephone_number": "586-726-9860"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "11800 E 12 Mile Rd",
            "address_purpose": "LOCATION",
            "city": "Warren",
            "state": "MI",
            "postal_code": "480933472",
            "country_code": "US",
            "telephone_number": "586-573-5111",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BOLOS",
        "first_name": "CRYSTAL",
        "middle_name": "ANNE",
        "name_prefix": "Mrs.",
        "credential": "FNP-BC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-01-26",
        "last_updated": "2022-01-26",
        "certification_date": "2022-01-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "MI",
            "license": "2021100905",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "crystal.bolos@ascension.org",
            "affiliation": "N",
            "endpointDescription": "email",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "Records or information",
            "address_1": "11800 E 12 Mile Rd",
            "city": "Warren",
            "state": "MI",
            "country_code": "US",
            "postal_code": "480933472",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Raquel Frances Blattert
• Eileen F Blodgett
• Elizabeth Blondell
• Ann Marie Boeskool, PA-C
• Erin Boguslawski, DPT
• Joseph Dante Bommarito, PROFESSIONAL COUNSEL
• Trina Bond
• Emily P Bongiorno
• Madelyn Bongiorno
• Emily Ann Bonk, MA, CCC-SLP

• Family Nurse Practitioner in Shelby Township, MI
• Providers in Shelby Township, MI by specialty
• Family Nurse Practitioner in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 26, 2022; 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.