Provider Demographics
NPI:1922811231
Name:BOLWERK, JOSHUA LEE (APRN)
Entity type:Individual
Prefix:MR
First Name:JOSHUA
Middle Name:LEE
Last Name:BOLWERK
Suffix:
Gender:M
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10106 STARRY NIGHT LN
Mailing Address - Street 2:
Mailing Address - City:MANVEL
Mailing Address - State:TX
Mailing Address - Zip Code:77578-1809
Mailing Address - Country:US
Mailing Address - Phone:903-241-1924
Mailing Address - Fax:
Practice Address - Street 1:10106 STARRY NIGHT LN
Practice Address - Street 2:
Practice Address - City:MANVEL
Practice Address - State:TX
Practice Address - Zip Code:77578-1809
Practice Address - Country:US
Practice Address - Phone:903-241-1924
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-01-30
Last Update Date:2025-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1172154363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care