Provider Demographics
NPI:1316752306
Name:BOLDMAN, AMANDA SUE
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:SUE
Last Name:BOLDMAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:393 EARTHWOOD LN
Mailing Address - Street 2:
Mailing Address - City:WEST UNION
Mailing Address - State:OH
Mailing Address - Zip Code:45693-9248
Mailing Address - Country:US
Mailing Address - Phone:937-779-9213
Mailing Address - Fax:
Practice Address - Street 1:393 EARTHWOOD LN
Practice Address - Street 2:
Practice Address - City:WEST UNION
Practice Address - State:OH
Practice Address - Zip Code:45693-9248
Practice Address - Country:US
Practice Address - Phone:937-779-9213
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-08
Last Update Date:2025-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH401696351014374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide