=====================================================
General NPI Number Information
=====================================================
NPI Number | 1366601361
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MELISSA RAMEY BOLDEN CRNP
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/04/2008
-----------------------------------------------------
Last Update Date | 10/16/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 8927 FINGERBOARD RD SUITE E
-----------------------------------------------------
City | FREDERICK
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 21704-8164
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 301-810-5740
-----------------------------------------------------
Fax | 301-810-5742
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1890 THURSTON RD
-----------------------------------------------------
City | DICKERSON
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 20842-8733
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 301-606-1200
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LA2200X
-----------------------------------------------------
Taxonomy Name | Adult Health Nurse Practitioner
-----------------------------------------------------
License Number | R122440
-----------------------------------------------------
License Number State | MD
-----------------------------------------------------