Healthcare Provider Details

I. General information

NPI: 1750602132
Provider Name (Legal Business Name): DAVID BOLEY
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/19/2010
Last Update Date: 04/06/2023
Certification Date: 04/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

931 CHATHAM LN
COLUMBUS OH
43221-2417
US

IV. Provider business mailing address

216 PARK AVE APT. #4
NEWPORT KY
41071-4580
US

V. Phone/Fax

Practice location:
  • Phone: 614-533-5500
  • Fax:
Mailing address:
  • Phone: 650-868-1945
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WP0000X
TaxonomyPain Management Registered Nurse
License NumberRN60258185
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberAP60258141
License Number StateWA
# 3
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberRN.332736-1
License Number StateOH
# 4
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number18988
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: