Healthcare Provider Details

I. General information

NPI: 1730016395
Provider Name (Legal Business Name): MICHELE BOLCHALK RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/07/2026
Last Update Date: 05/07/2026
Certification Date: 05/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4095 SHERIDAN DR
VIENNA OH
44473-9673
US

IV. Provider business mailing address

4095 SHERIDAN DR
VIENNA OH
44473-9673
US

V. Phone/Fax

Practice location:
  • Phone: 330-637-3500
  • Fax: 330-539-9036
Mailing address:
  • Phone: 330-637-3500
  • Fax: 330-539-9036

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WS0200X
TaxonomySchool Registered Nurse
License NumberRN.254186
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: