Provider Demographics
NPI:1417115783
Name:BOALES, SALLY ANN (RN)
Entity Type:Individual
Prefix:MS
First Name:SALLY
Middle Name:ANN
Last Name:BOALES
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1100 DENNISON AVE
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43201-3262
Mailing Address - Country:US
Mailing Address - Phone:614-884-4400
Mailing Address - Fax:614-884-4484
Practice Address - Street 1:1100 DENNISON AVE
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43201-3262
Practice Address - Country:US
Practice Address - Phone:614-884-4400
Practice Address - Fax:614-884-4484
Is Sole Proprietor?:No
Enumeration Date:2008-05-23
Last Update Date:2008-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN141130163WA2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WA2000XNursing Service ProvidersRegistered NurseAdministrator