Boltz, Jerome Dorian
Boltz, Jerome Dorian is an individual health care provider with primary practice located at Medical Center Blvd , Winston Salem NC 27157-0001. He recently has 2 registered licenses in different health care specialties including Physician Assistants & Advanced Practice Nursing Providers / Family, Physician Assistants & Advanced Practice Nursing Providers / Nurse Practitioner. Physician Assistants & Advanced Practice Nursing Providers / Nurse Practitioner is his primary health care specialty. Boltz, Jerome Dorian can be contacted via phone (336) 716-2011.Contact Information
Primary practice address
Medical Center Blvd
Winston Salem NC 27157-0001
Phone: (336) 716-2011
Fax: (336) 716-7359
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Physician Assistants & Advanced Practice Nursing Providers / Family | 363LF0000X | 5005247 | North Carolina |
| Physician Assistants & Advanced Practice Nursing Providers / Nurse Practitioner | 363L00000X | 5005247 | North Carolina |
Profile Details
| NPI number | 1578510384 |
|---|---|
| LBN Legal business name | Boltz, Jerome Dorian |
| Credentials | Nurse Practitioner (NP) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | May 27th, 2006 |
| Last updated | Jan 5th, 2022 - about 3 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1578510384 | NPPES |
| North Carolina | Other | 1955 A | MEDICARE PROVIDER # |
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