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General NPI Number Information
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NPI Number | 1861012247
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Entity Type | Individual
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Provider Name | EMILY ANN BOLENDER MD
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Gender | Female
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Dates
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Enumeration Date | 04/25/2020
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Last Update Date | 06/30/2023
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Provider Practice Location Address
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Address Line | 1334 N LANSING AVE
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City | TULSA
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State | OK
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Zip | 74106-5907
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Country | US
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Telephone | 918-587-2171
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Fax | 918-587-4534
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Provider Business Mailing Address
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Address Line | 3415 S DOGWOOD AVE
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City | BROKEN ARROW
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State | OK
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Zip | 74012-7564
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Country | US
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Telephone | 817-689-8878
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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 | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 36039
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License Number State | OK
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