Organization
BOELLA ENTERPRISES,LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. TRINA RENEE CAIN APRN,BC (PRESIDENT)
(770) 419-1799
Entity
Organization
Contact information
Practice address
811 KENNESAW AVE NW, MARIETTA, GA 30060-1002
(770) 422-2451
(770) 499-2235
Mailing address
4277 STEF LN NW, KENNESAW, GA 30152-7700
(770) 419-1799
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
RN054027NP
GA
Other
Enumeration date
01/18/2010
Last updated
07/20/2011
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