Healthcare Provider Details

I. General information

NPI: 1477817013
Provider Name (Legal Business Name): BREANNA KEENAN BOLIVAR M.D., MPH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/28/2012
Last Update Date: 06/23/2020
Certification Date: 06/23/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

119 HENDERSONVILLE RD
ASHEVILLE NC
28803-2868
US

IV. Provider business mailing address

119 HENDERSONVILLE RD
ASHEVILLE NC
28803-2868
US

V. Phone/Fax

Practice location:
  • Phone: 828-771-5500
  • Fax: 828-257-4750
Mailing address:
  • Phone: 828-771-5000
  • Fax: 828-257-4750

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207VX0000X
TaxonomyObstetrics Physician
License Number2014-02009
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License Number2014-02009
License Number StateNC
# 3
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number2014-02009
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: