Healthcare Provider Details

I. General information

NPI: 1285877043
Provider Name (Legal Business Name): MRS. ANN-CHRISTIN BOLEY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/09/2009
Last Update Date: 04/09/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1325 EAST WEST HWY. SSMC#2, #9300
SILVER SPRING MD
20910-3280
US

IV. Provider business mailing address

1325 EAST WEST HWY.
SILVER SPRING MD
20910-3280
US

V. Phone/Fax

Practice location:
  • Phone: 301-713-0545
  • Fax: 301-713-0379
Mailing address:
  • Phone: 301-713-0545
  • Fax: 301-713-0379

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberR117114
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberRN60240
License Number StateDC
# 3
Primary TaxonomyN
Taxonomy Code363LX0106X
TaxonomyOccupational Health Nurse Practitioner
License NumberR117114
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: