Provider Demographics
NPI:1649068693
Name:BOLDEN, ANGELA RENEE
Entity type:Individual
Prefix:
First Name:ANGELA
Middle Name:RENEE
Last Name:BOLDEN
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1630 ADDISON RD S
Mailing Address - Street 2:
Mailing Address - City:DISTRICT HEIGHTS
Mailing Address - State:MD
Mailing Address - Zip Code:20747-1567
Mailing Address - Country:US
Mailing Address - Phone:202-751-5769
Mailing Address - Fax:
Practice Address - Street 1:1630 ADDISON RD S
Practice Address - Street 2:
Practice Address - City:DISTRICT HEIGHTS
Practice Address - State:MD
Practice Address - Zip Code:20747-1567
Practice Address - Country:US
Practice Address - Phone:202-751-5769
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-04-29
Last Update Date:2025-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant