Healthcare Provider Details

I. General information

NPI: 1255510657
Provider Name (Legal Business Name): MELANIE LYNN BOLES CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/01/2007
Last Update Date: 03/05/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4145 CARMICHAEL RD
MONTGOMERY AL
36106-2803
US

IV. Provider business mailing address

3851 PIPER ST STE U340
ANCHORAGE AK
99508-6904
US

V. Phone/Fax

Practice location:
  • Phone: 334-273-7000
  • Fax:
Mailing address:
  • Phone: 334-273-7000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number138204
License Number StateAK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: