Individual
AMY L BOLES
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
1421 PREMIER DRIVE, MANKATO CLINIC AT WICKERSHAM CAMPUS, MANKATO, MN 56001
(507) 625-1811
Mailing address
PO BOX 8674, 1230 E MAIN STREET MANKATO CLINIC LTD, MANKATO, MN 56001
(507) 625-1811
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
48427
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
01-23833
MEDICA
MN
05
—
057753700
—
MN
01
—
0724203
IOWA MA
—
01
—
133219
UCARE
MN
01
—
2443242
AMERICA'S PPO
MN
01
—
523P5BO
BCBS
MN
01
—
54093
SANFORD HEALTH PLAN
MN
01
—
HP64495
HEALTH PARTNERS
MN
01
—
NA2951047341
PREFERRED ONE
MN
Enumeration date
10/31/2005
Last updated
07/09/2020
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