Individual
MARY LYNN LEY BOLDEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
4464 S DIXIE HWY, MIDDLETOWN, OH 45005-5464
(513) 649-8008
Mailing address
4464 S DIXIE HWY, MIDDLETOWN, OH 45005-5464
Taxonomy
Speciality
Code
Description
License number
State
163WP0808X
Psychiatric/Mental Health Registered Nurse
Primary
RN.237267
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0074946
—
OH
Enumeration date
01/09/2019
Last updated
01/14/2019
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