Individual
MARY BOLELA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
242 HOLLY HILL DR, JACKSON, MS 39212-5867
(601) 573-9458
Mailing address
242 HOLLY HILL DR, JACKSON, MS 39212-5867
(601) 573-9458
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
875417
MS
3104A0625X
Assisted Living Facility (Mental Illness)
Primary
—
—
Other
Enumeration date
01/29/2024
Last updated
01/29/2024
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