Provider Demographics
NPI:1023746369
Name:BOLTE, KATIE (MS, RD, EP-C)
Entity type:Individual
Prefix:
First Name:KATIE
Middle Name:
Last Name:BOLTE
Suffix:
Gender:F
Credentials:MS, RD, EP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2100 MADIS CT
Mailing Address - Street 2:
Mailing Address - City:PRINCE FREDERICK
Mailing Address - State:MD
Mailing Address - Zip Code:20678-3581
Mailing Address - Country:US
Mailing Address - Phone:402-366-8725
Mailing Address - Fax:
Practice Address - Street 1:2100 MADIS CT
Practice Address - Street 2:
Practice Address - City:PRINCE FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:20678-3581
Practice Address - Country:US
Practice Address - Phone:402-366-8725
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-14
Last Update Date:2022-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
171400000X
MDDX5041133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
No171400000XOther Service ProvidersHealth & Wellness Coach