Individual
ANGELA L. BOLEWARE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP
Contact information
Practice address
2500 NORTH STATE STREET, DEPARTMENT OF MEDICINE/DIVISION OF GENERAL INTERNAL MED, JACKSON, MS 39216-4500
(601) 984-5660
Mailing address
2500 NORTH STATE STREET, DEPT OF INTERNAL MEDICINE, JACKSON, MS 39216-4500
(601) 984-5660
(601) 984-6870
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
R543195
MS
363L00000X
Nurse Practitioner
Primary
R543195
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
09538704
—
MS
01
—
P01236766
RAILROAD MEDICARE PTAN
MS
01
—
RR P00321105
RAILROAD
MS
Enumeration date
07/20/2006
Last updated
04/08/2014
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