Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207RN0300X | Nephrologist | 4505 | OK |
NPI | 1013119650 |
---|---|
Provider Name | Angela Dene Bolz |
First Address | Tulsa, OK 74136-3347 |
Second Address | Tulsa, OK 74133-5589 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/06/2007 |
Last Update Date | 01/11/2016 |