Individual
YVONNE BOLUMOLE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
APRN, RN
Contact information
Practice address
1 LONG WHARF DR, NEW HAVEN, CT 06511-5991
(203) 781-4600
(203) 781-4624
Mailing address
1 LONG WHARF DR STE 321, NEW HAVEN, CT 06511-5946
(203) 781-4600
(203) 781-4624
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
131378
CT
363LP2300X
Primary Care Nurse Practitioner
Primary
12365
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
004041000
—
CT
05
—
004217099
—
CT
05
—
008003745
—
CT
05
—
008122059
—
CT
Enumeration date
12/07/2018
Last updated
10/20/2023
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