Healthcare Provider Details

I. General information

NPI: 1902816531
Provider Name (Legal Business Name): ANN M BOLAR FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/08/2006
Last Update Date: 03/21/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2875 W RAY RD STE 16
CHANDLER AZ
85224-3619
US

IV. Provider business mailing address

11321 FALLBROOK DR
HOUSTON TX
77065-4232
US

V. Phone/Fax

Practice location:
  • Phone: 480-855-6075
  • Fax: 480-855-6085
Mailing address:
  • Phone: 832-237-3500
  • Fax: 832-237-0200

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberRN105897
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: