Individual
LACONIA VENAYE BOULDIN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
2760 RIVERSIDE DR, CINCINNATI, OH 45202-1820
(513) 837-3575
Mailing address
2760 RIVERSIDE DR, CINCINNATI, OH 45202-1820
(513) 837-3575
Taxonomy
Speciality
Code
Description
License number
State
372500000X
Chore Provider
Primary
—
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
563
—
OH
Enumeration date
10/04/2022
Last updated
10/04/2022
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