MEDICARE: JOSEPHINE BOLAY

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	171400000X	Health & Wellness Coach		AZ

General Provider Information

NPI Number	:	1942066857
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOSEPHINE BOLAY

Provider Business Mailing Address
First Line	:	7840 N 31ST AVE STE 201
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85051-6699
Country	:	US
Telephone Number	:	520-201-3807
Fax Number	:

Provider Business Practice Location Address
First Line	:	7840 N 31ST AVE STE 201
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85051-6699
Country	:	US
Telephone Number	:	520-201-3807
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/27/2024
Last Update Date	:	02/27/2024

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Directions to “ JOSEPHINE BOLAY ” Practice Location

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