Provider Demographics
NPI:1962795419
Name:BOLDER-CARR, DESHAWN DENISE (HHA CAREGIVER)
Entity type:Individual
Prefix:MRS
First Name:DESHAWN
Middle Name:DENISE
Last Name:BOLDER-CARR
Suffix:
Gender:F
Credentials:HHA CAREGIVER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:38757 DONALD ST
Mailing Address - Street 2:
Mailing Address - City:LIVONIA
Mailing Address - State:MI
Mailing Address - Zip Code:48154-4709
Mailing Address - Country:US
Mailing Address - Phone:734-744-7277
Mailing Address - Fax:734-744-7015
Practice Address - Street 1:38757 DONALD ST
Practice Address - Street 2:
Practice Address - City:LIVONIA
Practice Address - State:MI
Practice Address - Zip Code:48154-4709
Practice Address - Country:US
Practice Address - Phone:734-744-7277
Practice Address - Fax:734-744-7015
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-17
Last Update Date:2011-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
No372500000XNursing Service Related ProvidersChore Provider
No372600000XNursing Service Related ProvidersAdult Companion