Individual
MS. TANJA BOLLE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LM,CPM
Contact information
Practice address
968 ALTO ST, SANTA FE, NM 87501-2405
(505) 992-7104
Mailing address
968 ALTO ST, SANTA FE, NM 87501-2405
(505) 992-7104
Taxonomy
Speciality
Code
Description
License number
State
176B00000X
Midwife
Primary
95284R
NM
Other
Enumeration date
10/12/2006
Last updated
07/08/2007
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