Individual
ANITA BOLAND
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1020 DUTCH FORK RD, IRMO, SC 29063-8822
(803) 732-8242
Mailing address
1020 DUTCH FORK RD, IRMO, SC 29063-8822
Taxonomy
Speciality
Code
Description
License number
State
163WS0200X
School Registered Nurse
Primary
R 40522
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
003466631
—
SC
Enumeration date
11/04/2013
Last updated
11/04/2013
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