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General NPI Number Information
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NPI Number | 1790129872
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Entity Type | Individual
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Provider Name | AMY KATHERINE BOLES CRNA
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Gender | Female
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Dates
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Enumeration Date | 04/19/2013
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Last Update Date | 06/13/2022
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Provider Practice Location Address
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Address Line | 8219 LEESBURG PIKE STE 100
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City | VIENNA
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State | VA
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Zip | 22182-2625
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Country | US
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Telephone | 301-873-7508
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 918025
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City | ORLANDO
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State | FL
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Zip | 32891-8025
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Country | US
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Telephone |
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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 | 367500000X
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Taxonomy Name | Certified Registered Nurse Anesthetist
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License Number | ARNP9359225
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License Number State | FL
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