Healthcare Provider Details

I. General information

NPI: 1316370018
Provider Name (Legal Business Name): MICHELLE D BOLYARD NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MICHELLE D HESSELL-SOLTER NP

II. Dates (important events)

Enumeration Date: 08/16/2013
Last Update Date: 09/23/2026
Certification Date: 09/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7916 W JEFFERSON BLVD
FORT WAYNE IN
46804-4140
US

IV. Provider business mailing address

6920 POINTE INVERNESS WAY STE 200
FORT WAYNE IN
46804-7934
US

V. Phone/Fax

Practice location:
  • Phone: 260-432-2297
  • Fax: 260-434-6481
Mailing address:
  • Phone: 260-479-3514
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number71004680A
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number28169140A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: