MEDICARE: NICK BOLES

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	237700000X	Hearing Instrument Specialist	983	TN

General Provider Information

NPI Number	:	1114638681
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NICK BOLES

Provider Business Mailing Address
First Line	:	1705 W MAIN ST STE 207
Second Line	:
City	:	LEBANON
State	:	TN
Zip	:	37087-4889
Country	:	US
Telephone Number	:	615-449-2500
Fax Number	:

Provider Business Practice Location Address
First Line	:	1705 W MAIN ST STE 207
Second Line	:
City	:	LEBANON
State	:	TN
Zip	:	37087-4889
Country	:	US
Telephone Number	:	615-449-2500
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/06/2022
Last Update Date	:	12/06/2022

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Directions to “ NICK BOLES ” Practice Location

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