Provider Demographics
NPI:1275232274
Name:BOLES, GIANNA (FNP-C)
Entity Type:Individual
Prefix:MRS
First Name:GIANNA
Middle Name:
Last Name:BOLES
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16 TYLER CT
Mailing Address - Street 2:
Mailing Address - City:MANLIUS
Mailing Address - State:NY
Mailing Address - Zip Code:13104-1741
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5 STATE ST
Practice Address - Street 2:
Practice Address - City:TULLY
Practice Address - State:NY
Practice Address - Zip Code:13159-3273
Practice Address - Country:US
Practice Address - Phone:315-696-4635
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-02-28
Last Update Date:2024-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF351074-01363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily