Individual
ANNETTE BOLDEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1545 LINE AVE STE 330A, SHREVEPORT, LA 71101-4600
(318) 409-9636
Mailing address
1931 ASHTON ST, SHREVEPORT, LA 71103-2625
(318) 409-9636
Taxonomy
Speciality
Code
Description
License number
State
376J00000X
Homemaker
Primary
30042
LA
Other
Enumeration date
03/01/2023
Last updated
03/01/2023
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