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General NPI Number Information
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NPI Number | 1386182186
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Entity Type | Individual
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Provider Name | ASHLEY BOLLER PA-C
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Gender | Female
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Dates
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Enumeration Date | 02/01/2017
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Last Update Date | 11/07/2024
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Provider Practice Location Address
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Address Line | 5333 MCAULEY DR SUITE 6109
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City | YPSILANTI
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State | MI
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Zip | 48197
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Country | US
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Telephone | 734-712-1400
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Fax | 734-623-2857
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Provider Business Mailing Address
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Address Line | 24 FRANK LLOYD WRIGHT DRIVE SUITE J2000
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City | ANN ARBOR
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State | MI
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Zip | 48105
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Country | US
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Telephone | 734-747-6766
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Fax | 734-222-3100
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | C5-0001216
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License Number State | DE
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Taxonomy #2
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA9109725
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License Number State | FL
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Taxonomy #3
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 5601012157
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License Number State | MI
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