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Deactivated NPI 1033183256 Deactivated / Inactive NPI Female Practitioner

Dr. Jennifer L Bolduc , MD

Pediatrics • Walla Walla, WA

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Notice of NPI Deactivation & Inactive Practice Status

According to official public domain records published by CMS (Centers for Medicare & Medicaid Services) in the National Provider Identifier (NPPES) Registry, Dr. Jennifer Bolduc has officially deactivated this NPI record and ceased active healthcare practice.

Registration / Start Date February 14, 2006
NPI Deactivation Date October 11, 2024
Total Practice Duration ~18 Years of Practice (2006 – 2024)

Professional Overview & Biography Verified Profile Summary

Dr. Jennifer Bolduc, MD was a registered Pediatrics practicing in Walla Walla, WA. Throughout an active medical career spanning 18 years, Dr. Bolduc provided care at the practice location at 55 W TIETAN ST until profile deactivation on 2024-10-11.

Practice Location & Contact Primary Location

Practice Address

55 W Tietan St

Walla Walla, WA 993624445

Telephone 5095253720
Fax 5095221578
Associated Practice Facility / Clinic

Specialty Benchmarks & Practice Insights

Comparative analytics for Pediatrics in Walla Walla, WA

Active Practitioner
Practitioner Clinical Experience
Active
City Avg: 19.7 Yrs
State Avg: 18.8 Yrs
Regional Practice Density
15 Specialists

Practicing in Walla Walla, WA (1802 Statewide)

Telehealth Adoption Rate
0.0% Regional Adoption

In-Person Office Visits Only

Medicare Pricing Discount
67.4% Avg Savings

Under CMS Medicare Fee Schedule vs Standard Submitted Charges

Medical Specialties & State Licenses

Pediatrics Primary Specialty

NUCC Taxonomy Code: 208000000X

State License WA MD00042057

A pediatrician is concerned with the physical, emotional and social health of children from birth to young adulthood. Care encompasses a broad spectrum of health services ranging from preventive healthcare to the diagnosis and treatment of acute and chronic diseases. A pediatrician deals with biological, social and environmental influences on the developing child, and with the impact of disease and dysfunction on development.

Practice Associates & Co-Workers

Healthcare professionals and specialists practicing at this location or sharing practice phone/fax

40 Associated Practitioners
NPI 1013975036

Doctor of Medicine (M.D.)

Stacey Haveman , PHYSICIAN ASSISTANT

Physician Assistant - Medical

NPI 1023309796

PHYSICIANASSISTANT

Dr. Justin Olswanger , DO

Family Medicine - Adult Medicine

NPI 1033265657

Doctor of Osteopathic Medicine (D.O.)

Dr. John Moore , DO

Family Medicine

NPI 1063412070

Doctor of Osteopathic Medicine (D.O.)

NPI 1073856043

Doctor of Medicine (M.D.)

NPI 1083096440

Doctor of Medicine (M.D.)

Career & Practice History Timeline

Chronological log of verified NPI updates, location relocations, credentials, and registry changes

7 Historical Events
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NPI Profile Deactivated October 11, 2024

Record deactivated on October 11, 2024

NPI Profile Active November 27, 2007

NPI status registered as active in NPPES database

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Updated Practice Location November 27, 2007

Registered at 55 W TIETAN ST, WALLA WALLA, WA 993624445 (Tel: 5095253720)

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Updated Business Mailing Address November 27, 2007

Registered at 55 W TIETAN ST, WALLA WALLA, WA 993624445 (Tel: 5095253720)

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Provider Name / Credentials Updated November 27, 2007

Recorded as JENNIFER BOLDUC, M.D.

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Medical Taxonomy / Specialty Registered (Primary Specialty) November 27, 2007

Pediatrics (License #MD00042057 in WA)

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Initial NPI Registration & Enumeration February 14, 2006

First registered as active Individual Practitioner in NPPES Database.

Patient & Community Reviews

Verified patient ratings, medical care experiences, and facility photos

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NPI Administrative Meta

NPI Number: 1033183256
Entity Type:
Individual Provider Physician, Nurse Practitioner, or Solo Healthcare Professional (Type 1 NPI)
Enumeration Date: February 14, 2006
Last Update: November 27, 2007
Deactivation Date: October 11, 2024

Mailing Address

55 W Tietan St

Walla Walla, WA 993624445

Phone: 5095253720

Public Domain Record This profile contains public domain information published by CMS and NPPES under the Freedom of Information Act (FOIA).
⚠️ Medical Disclaimer

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