Healthcare Provider Details

I. General information

NPI: 1619839313
Provider Name (Legal Business Name): FATU T BOLAY RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/01/2025
Last Update Date: 12/01/2025
Certification Date: 12/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5254 SANDERS DR
COLUMBUS OH
43213-7637
US

IV. Provider business mailing address

5254 SANDERS DR
COLUMBUS OH
43213-7637
US

V. Phone/Fax

Practice location:
  • Phone: 614-687-4939
  • Fax: 614-687-4939
Mailing address:
  • Phone: 614-687-4939
  • Fax: 614-687-4939

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN538499
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: