Provider Demographics
NPI:1548647225
Name:BOLDUC, KATELYN A (FNP)
Entity type:Individual
Prefix:
First Name:KATELYN
Middle Name:A
Last Name:BOLDUC
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:KATELYN
Other - Middle Name:
Other - Last Name:RASCHE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:25 FIRST PARK DR
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04963-5369
Mailing Address - Country:US
Mailing Address - Phone:207-465-4000
Mailing Address - Fax:207-465-4629
Practice Address - Street 1:25 FIRST PARK DR
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:ME
Practice Address - Zip Code:04963-5369
Practice Address - Country:US
Practice Address - Phone:207-465-4000
Practice Address - Fax:207-465-4629
Is Sole Proprietor?:No
Enumeration Date:2015-05-01
Last Update Date:2023-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MECNP151076363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily