Individual
MS. NICOLE KRISTIN BOLES
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LPN
Contact information
Practice address
922 BLY ST., JOPPA, IL 62953
(618) 309-2455
Mailing address
341 STATE ROUTE 1628, BARDWELL, KY 42023-8530
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
043.120833
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
043.120833
LICENSED PRACTICAL NURSE
IL
Enumeration date
06/21/2017
Last updated
06/21/2017
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