Individual
MICHELLE D BOLYARD
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
2500 N DETROIT ST, LAGRANGE, IN 46761-1158
(260) 463-2133
Mailing address
PO BOX 236, LAGRANGE, IN 46761-0236
(260) 463-2133
(260) 463-3775
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
28169140A
IN
363LG0600X
Gerontology Nurse Practitioner
Primary
71004680A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
201194780
—
IN
Enumeration date
08/16/2013
Last updated
06/02/2025
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