Provider Demographics
NPI:1699028928
Name:BOLDEN, GABRIELLE DANIELLE
Entity type:Individual
Prefix:
First Name:GABRIELLE
Middle Name:DANIELLE
Last Name:BOLDEN
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 1:2628 DELMAR BLVD
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63103-1404
Mailing Address - Country:US
Mailing Address - Phone:314-361-5800
Mailing Address - Fax:
Practice Address - Street 1:220 FALCON
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63031-3408
Practice Address - Country:US
Practice Address - Phone:314-498-4794
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-24
Last Update Date:2024-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health