Individual
MRS. WILLIE MARY BOLDEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
112 W PEELER AVE, SHAW, MS 38773-8710
(662) 745-6638
Mailing address
112 W PEELER AVE, SHAW, MS 38773-8710
(662) 754-3301
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
903205
MS
Other
Enumeration date
03/26/2019
Last updated
03/26/2019
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