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Individual
PHALAN LARESE BOLDEN
Active
Individual
PHALAN LARESE BOLDEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
255762
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1184952277
—
NC
05
—
7006359
—
NC
05
—
NP2129
—
SC
Enumeration date
12/01/2009
Last updated
05/09/2019
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