Healthcare Provider Details

I. General information

NPI: 1396154977
Provider Name (Legal Business Name): LESLIE KAYE BOLANDER CNM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/07/2014
Last Update Date: 09/16/2022
Certification Date: 09/16/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

485 S. DOBSON ROAD SUITE 200
CHANDLER AZ
85224-5602
US

IV. Provider business mailing address

1661 E CAMELBACK ROAD SUITE 200
PHOENIX AZ
85016-3913
US

V. Phone/Fax

Practice location:
  • Phone: 480-782-0993
  • Fax: 833-337-0386
Mailing address:
  • Phone: 602-422-9000
  • Fax: 602-556-5951

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code176B00000X
TaxonomyMidwife
License Number148898
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License NumberAP11530
License Number StateAZ
# 3
Primary TaxonomyY
Taxonomy Code176B00000X
TaxonomyMidwife
License NumberRN238909
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: