MEDICARE: ELLA DARICE BOLEY

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	174H00000X	Health Educator	14226	AL

General Provider Information

NPI Number	:	1245703008
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELLA DARICE BOLEY

Provider Business Mailing Address
First Line	:	100 ALEXANDRIA DR
Second Line	:
City	:	HUNTSVILLE
State	:	AL
Zip	:	35806-4223
Country	:	US
Telephone Number	:	256-679-0532
Fax Number	:

Provider Business Practice Location Address
First Line	:	2110 OAKWOOD AVE NW
Second Line	:
City	:	HUNTSVILLE
State	:	AL
Zip	:	35810-4404
Country	:	US
Telephone Number	:	256-539-5136
Fax Number	:	256-551-3200

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

Provider Enumeration Date	:	01/04/2019
Last Update Date	:	01/04/2019

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Directions to “ ELLA DARICE BOLEY ” Practice Location

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