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General NPI Number Information
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NPI Number | 1619714151
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Entity Type | Individual
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Provider Name | JESSICA MARIE BOLANO APRN, FNP-BC
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Gender | Female
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Dates
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Enumeration Date | 07/11/2024
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Last Update Date | 10/24/2024
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Provider Practice Location Address
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Address Line | 1249 15TH STREET SUITE 3000
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City | HUNTINGTON
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State | WV
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Zip | 25701-3663
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Country | US
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Telephone | 304-691-1000
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Fax | 304-691-1693
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Provider Business Mailing Address
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Address Line | 1448 10TH AVENUE SUITE 304
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City | HUNTINGTON
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State | WV
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Zip | 25701-3579
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Country | US
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Telephone | 304-691-6381
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Fax | 304-691-8591
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 120342
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License Number State | WV
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