Provider Demographics
NPI:1487430385
Name:BOLON, TINA
Entity type:Individual
Prefix:
First Name:TINA
Middle Name:
Last Name:BOLON
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 1:8340 VIEWPOINT LN
Mailing Address - Street 2:
Mailing Address - City:CORNELIUS
Mailing Address - State:NC
Mailing Address - Zip Code:28031-8231
Mailing Address - Country:US
Mailing Address - Phone:980-248-0358
Mailing Address - Fax:
Practice Address - Street 1:8340 VIEWPOINT LN
Practice Address - Street 2:
Practice Address - City:CORNELIUS
Practice Address - State:NC
Practice Address - Zip Code:28031-8231
Practice Address - Country:US
Practice Address - Phone:980-248-0358
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-06
Last Update Date:2023-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider