Healthcare Provider Details

I. General information

NPI: 1750200549
Provider Name (Legal Business Name): JOLYNN FAITH BOFAH DNP, CNM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/14/2026
Last Update Date: 09/24/2026
Certification Date: 09/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5629 LEE RD
INDIANAPOLIS IN
46216-2003
US

IV. Provider business mailing address

5629 LEE RD
INDIANAPOLIS IN
46216-2003
US

V. Phone/Fax

Practice location:
  • Phone: 317-419-6800
  • Fax:
Mailing address:
  • Phone: 317-419-6800
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number28259407A
License Number StateIN
# 2
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License Number09000535A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: