Individual
MRS. BRENDA S. BOLING
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
315 E BROADWAY, LOUISVILLE, KY 40202-1703
(502) 629-2500
(502) 629-3166
Mailing address
PO BOX 776347, CHICAGO, IL 60677-6347
(502) 629-2500
(502) 629-3166
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
4079P
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000310996
ANTHEM PROVIDER NO.
KY
05
—
200455700
—
IN
01
—
50006768
PASSPORT PROVIDER NO
KY
05
—
78013604
—
KY
01
—
P00110157
RAILROAD MEDICARE
KY
Enumeration date
05/16/2006
Last updated
07/07/2016
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