Provider Demographics
NPI:1285046409
Name:HARDEN BOSTIC, ALLISON DIONNE (CNA CERTIFIED NURS)
Entity type:Individual
Prefix:MRS
First Name:ALLISON
Middle Name:DIONNE
Last Name:HARDEN BOSTIC
Suffix:
Gender:F
Credentials:CNA CERTIFIED NURS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1557 BROWN RD
Mailing Address - Street 2:
Mailing Address - City:HEPHZIBAH
Mailing Address - State:GA
Mailing Address - Zip Code:30815
Mailing Address - Country:US
Mailing Address - Phone:706-421-7033
Mailing Address - Fax:706-814-5623
Practice Address - Street 1:1557 BROWN RD
Practice Address - Street 2:
Practice Address - City:HEPHZIBAH
Practice Address - State:GA
Practice Address - Zip Code:30815
Practice Address - Country:US
Practice Address - Phone:706-421-7033
Practice Address - Fax:706-814-5623
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-22
Last Update Date:2014-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACN0000066881376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide