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General NPI Number Information
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NPI Number | 1265032445
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Entity Type | Individual
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Provider Name | JENNI LAYNE BOLTON APRN-CNP, AGNP-C
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Gender | Female
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Dates
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Enumeration Date | 10/28/2020
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Last Update Date | 02/09/2021
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Provider Practice Location Address
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Address Line | 550 SUMMIT AVE STE 101
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City | TROY
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State | OH
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Zip | 45373-3047
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Country | US
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Telephone | 937-335-5191
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Fax |
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Provider Business Mailing Address
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Address Line | 3170 KETTERING BLVD BLDG B3
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City | MORAINE
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State | OH
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Zip | 45439-1924
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Country | US
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Telephone | 937-991-3100
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Fax | 937-223-9811
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number | 0027579
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License Number State | OH
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