| Doctor Name: | MRS. MARY JANE BOLBACH |
| NPI Number: | 1033326632 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | CRNP |
| License Number: | NP 02735 |
| Business Practice Address: | 5300 Harroun Rd Ste 119 Sylvania, OH - 435602182 |
| Business Phone Number: | 4198851161 |
| Business Fax Number: | 4198245199 |
| Mailing Address: | 3010 Middlesex Dr, TOLEDO |
| State: | OH |
| Postal Code: | 436063075 |
| Phone Number: | 4195314846 |
| Fax Number: | 4198245199 |
| NPI Enumeration Date: | 05/16/2007 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LW0102X |
| License Number: | NP 02735 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | OH |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Women's Health |
| Taxonomy Definition: | |