Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LF0000X | Nurse Practitioner - Family Medicine | SP014123 | PA |
NPI | 1003211665 |
---|---|
Provider Name | Michelle Diane Bolz |
First Address | Nashville, TN 37201-1826 |
Second Address | Pittsburgh, PA 15228-2021 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/10/2014 |
Last Update Date | 19/04/2016 |