Provider Demographics
NPI:1427293802
Name:BOLDEN, SHERRY YVONNE (LPN)
Entity type:Individual
Prefix:MRS
First Name:SHERRY
Middle Name:YVONNE
Last Name:BOLDEN
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:247 ALLANHURST AVE
Mailing Address - Street 2:
Mailing Address - City:VANDALIA
Mailing Address - State:OH
Mailing Address - Zip Code:45377-1718
Mailing Address - Country:US
Mailing Address - Phone:937-890-8473
Mailing Address - Fax:
Practice Address - Street 1:247 ALLANHURST AVE
Practice Address - Street 2:
Practice Address - City:VANDALIA
Practice Address - State:OH
Practice Address - Zip Code:45377-1718
Practice Address - Country:US
Practice Address - Phone:937-890-8473
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-12
Last Update Date:2008-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN.089684164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse