Individual
TANNA LYNN BOLDEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
312 BARBARA DR, WAUSEON, OH 43567-8881
(567) 454-1435
Mailing address
312 BARBARA DR, WAUSEON, OH 43567-8881
(567) 454-1435
Taxonomy
Speciality
Code
Description
License number
State
376K00000X
Nurse's Aide
Primary
324290670817
OH
Other
Enumeration date
10/27/2017
Last updated
10/27/2017
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