Healthcare Provider Details

I. General information

NPI: 1427682822
Provider Name (Legal Business Name): JENNA RENEE BOLEY FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/25/2020
Last Update Date: 07/30/2024
Certification Date: 02/25/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

855 A AVE NE STE 200
CEDAR RAPIDS IA
52402-5064
US

IV. Provider business mailing address

855 A AVENUE NE PO BOX 3080
CEDAR RAPIDS IA
52406-3080
US

V. Phone/Fax

Practice location:
  • Phone: 319-391-5501
  • Fax: 319-743-2610
Mailing address:
  • Phone: 319-391-5501
  • Fax: 319-743-2610

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberA158037
License Number StateIA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: