Individual
PATRICIA BOLEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
200 12TH STREET EXT, PRINCETON, WV 24740-2329
(304) 425-9541
Mailing address
200 12TH STREET EXT, PRINCETON, WV 24740-2329
(304) 425-9541
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0005489001
—
WV
Enumeration date
08/11/2020
Last updated
08/11/2020
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