Healthcare Provider Details

I. General information

NPI: 1881227700
Provider Name (Legal Business Name): EVA BOLDEA M.S.N.-ACNS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/19/2020
Last Update Date: 02/19/2020
Certification Date: 02/19/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

810 E ROSS AVE
PHOENIX AZ
85024-4146
US

IV. Provider business mailing address

810 E ROSS AVE
PHOENIX AZ
85024-4146
US

V. Phone/Fax

Practice location:
  • Phone: 480-415-1088
  • Fax:
Mailing address:
  • Phone: 480-415-1088
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364SA2200X
TaxonomyAdult Health Clinical Nurse Specialist
License NumberAP4650
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: