Provider Demographics
NPI:1285877043
Name:BOLEY, ANN-CHRISTIN
Entity type:Individual
Prefix:MRS
First Name:ANN-CHRISTIN
Middle Name:
Last Name:BOLEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1325 EAST WEST HWY.
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20910-3280
Mailing Address - Country:US
Mailing Address - Phone:301-713-0545
Mailing Address - Fax:301-713-0379
Practice Address - Street 1:1325 EAST WEST HWY.
Practice Address - Street 2:SSMC#2, #9300
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20910-3280
Practice Address - Country:US
Practice Address - Phone:301-713-0545
Practice Address - Fax:301-713-0379
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-09
Last Update Date:2009-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR117114363LA2200X, 363LX0106X
DCRN60240363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363LX0106XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerOccupational Health