Healthcare Provider Details

I. General information

NPI: 1003211665
Provider Name (Legal Business Name): MICHELLE DIANE BOLZ CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/24/2014
Last Update Date: 04/19/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

788 WASHINGTON RD
PITTSBURGH PA
15228-2021
US

IV. Provider business mailing address

333 COMMERCE ST SUITE 700
NASHVILLE TN
37201-1826
US

V. Phone/Fax

Practice location:
  • Phone: 412-307-4609
  • Fax: 888-878-3824
Mailing address:
  • Phone: 615-627-2265
  • Fax: 888-494-2588

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberSP014123
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: