Provider Demographics
NPI:1730913815
Name:BOLAND, DEBBIE J (LPN)
Entity type:Individual
Prefix:
First Name:DEBBIE
Middle Name:J
Last Name:BOLAND
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2020 COUNTY ROUTE 12 APT 1
Mailing Address - Street 2:
Mailing Address - City:CENTRAL SQUARE
Mailing Address - State:NY
Mailing Address - Zip Code:13036-3316
Mailing Address - Country:US
Mailing Address - Phone:315-396-2097
Mailing Address - Fax:
Practice Address - Street 1:2020 COUNTY ROUTE 12 APT 1
Practice Address - Street 2:
Practice Address - City:CENTRAL SQUARE
Practice Address - State:NY
Practice Address - Zip Code:13036-3316
Practice Address - Country:US
Practice Address - Phone:315-396-2097
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-29
Last Update Date:2024-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY317451164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse