Individual
MR. JOSEPH LAWRENCE BOLAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
RD, CD
Contact information
Practice address
3303 SOLDIERS HOME RD, WEST LAFAYETTE, IN 47906-1219
(765) 497-4873
Mailing address
3303 SOLDIERS HOME RD, WEST LAFAYETTE, IN 47906-1219
(765) 497-4873
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
37000011A
IN
Other
Enumeration date
10/06/2009
Last updated
10/06/2009
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