Individual
MRS. HEATHER DIANA BOLTON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
307 F WEST MAIN ST, LEBANON, TN 37087
(615) 449-4151
(615) 449-1994
Mailing address
PO BOX 3322, LEBANON, TN 37088
(615) 449-4151
(615) 449-1994
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA1192
TN
Other
Enumeration date
06/15/2006
Last updated
10/03/2007
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