Doctor Name: | SEAN P. BOLEY |
NPI Number: | 1659630309 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | MD |
License Number: | |
Business Practice Address: | 535 Hospital Rd Ms17100a New Richmond, WI - 540171449 |
Business Phone Number: | 7152432600 |
Business Fax Number: | 7152462177 |
Mailing Address: | Po Box 1309, 8170 33rd Ave S - Mail Stop 21110q MINNEAPOLIS |
State: | MN |
Postal Code: | 554254516 |
Phone Number: | 7152432600 |
Fax Number: | 7152462177 |
NPI Enumeration Date: | 05/15/2012 |
NPI Last Update Date: | 07/01/2015 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 390200000X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | N |
State: | |
Taxonomy Type: | Student, Health Care |
Taxonomy Classification: | Student in an Organized Health Care Education/Training Program |
Taxonomy Specialization: | |
Taxonomy Definition: | An individual who is enrolled in an organized health care education/training program leading to a degree, certification, registration, and/or licensure to provide health care. |