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General NPI Number Information
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NPI Number | 1962427658
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Entity Type | Individual
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Provider Name | MARY T. BOLLES-HOLDER CNM, ARNP
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Gender | Female
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Dates
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Enumeration Date | 07/13/2006
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Last Update Date | 08/02/2024
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Provider Practice Location Address
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Address Line | 10330 MERIDIAN AVE N SUITE 190
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City | SEATTLE
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State | WA
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Zip | 98133-9451
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Country | US
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Telephone | 206-368-6670
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Fax | 206-368-6171
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Provider Business Mailing Address
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Address Line | PO BOX 50095
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City | SEATTLE
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State | WA
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Zip | 98145-5095
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Country | US
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Telephone | 206-520-5700
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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 | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | RN00089718
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License Number State | WA
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Taxonomy #2
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | AP30006303
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License Number State | WA
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Taxonomy #3
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Taxonomy Code | 367A00000X
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Taxonomy Name | Advanced Practice Midwife
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License Number | AP30006303
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License Number State | WA
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Taxonomy #4
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | AP61434065
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License Number State | WA
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