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General NPI Number Information
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NPI Number | 1407480932
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Entity Type | Individual
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Provider Name | MELANIE LEE BOLTZE
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Gender | Female
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Dates
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Enumeration Date | 02/24/2020
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Last Update Date | 02/24/2020
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Provider Practice Location Address
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Address Line | 12409 W INDIAN SCHOOL RD
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City | AVONDALE
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State | AZ
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Zip | 85392-9502
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Country | US
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Telephone | 623-935-9920
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Fax | 623-935-9925
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Provider Business Mailing Address
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Address Line | 12409 W INDIAN SCHOOL RD STE B210
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City | AVONDALE
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State | AZ
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Zip | 85392-9505
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Country | US
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Telephone | 623-935-9920
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Fax |
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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 | 163WG0000X
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Taxonomy Name | General Practice Registered Nurse
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License Number | 165689
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License Number State | AZ
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