Provider Demographics
NPI:1437991460
Name:BOLDEN, YOLANDA RILEY
Entity type:Individual
Prefix:MRS
First Name:YOLANDA
Middle Name:RILEY
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 1:3234 MALLARD LN
Mailing Address - Street 2:
Mailing Address - City:GRETNA
Mailing Address - State:LA
Mailing Address - Zip Code:70056-8624
Mailing Address - Country:US
Mailing Address - Phone:504-400-5776
Mailing Address - Fax:
Practice Address - Street 1:3234 MALLARD LN
Practice Address - Street 2:
Practice Address - City:GRETNA
Practice Address - State:LA
Practice Address - Zip Code:70056-8624
Practice Address - Country:US
Practice Address - Phone:504-400-5776
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-11
Last Update Date:2024-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA3747A0650X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider