Individual
SHANNON BOLDENOW
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
44405 WOODWARD AVE, PONTIAC, MI 48341-5023
(248) 858-3000
Mailing address
4840 ALTON CT, TROY, MI 48085-5044
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
4704283091
MI
Other
Enumeration date
01/12/2020
Last updated
01/12/2020
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