Provider Demographics
NPI:1417753591
Name:BOLTON, PRISCILLA ALDEN (RN)
Entity type:Individual
Prefix:
First Name:PRISCILLA
Middle Name:ALDEN
Last Name:BOLTON
Suffix:
Gender:
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1060 LAWANNA DR
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30062-3119
Mailing Address - Country:US
Mailing Address - Phone:202-506-0428
Mailing Address - Fax:
Practice Address - Street 1:1060 LAWANNA DR
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30062-3119
Practice Address - Country:US
Practice Address - Phone:202-506-0428
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-20
Last Update Date:2025-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN306201163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant