Individual
LAUREN BOLES
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1818 CAREW ST STE 255, FORT WAYNE, IN 46805-4790
(260) 266-5260
(260) 458-5913
Mailing address
11109 PARKVIEW PLAZA DR # 117, FORT WAYNE, IN 46845-1701
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
28207858A
IN
363L00000X
Nurse Practitioner
Primary
71007946A
IN
Other
Enumeration date
03/20/2018
Last updated
10/11/2022
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