MEDICARE: MELISSA A BOLL CNM

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	176B00000X	Midwife	5713781-4402	UT

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1124080775
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MELISSA A BOLL CNM

Provider Business Mailing Address
First Line	:	6975 S UNION PARK CTR
Second Line	:
City	:	COTTONWOOD HEIGHTS
State	:	UT
Zip	:	84047-6048
Country	:	US
Telephone Number	:	888-731-8994
Fax Number	:	833-775-1861

Provider Business Practice Location Address
First Line	:	6975 S UNION PARK CTR STE 600
Second Line	:
City	:	COTTONWOOD HEIGHTS
State	:	UT
Zip	:	84047-4187
Country	:	US
Telephone Number	:	888-731-8994
Fax Number	:	888-732-8119

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

Provider Enumeration Date	:	04/06/2006
Last Update Date	:	03/20/2025

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