Provider Demographics
NPI:1780997395
Name:BOLTON, LEENA (CBS, CNHP)
Entity type:Individual
Prefix:MRS
First Name:LEENA
Middle Name:
Last Name:BOLTON
Suffix:
Gender:F
Credentials:CBS, CNHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7503 QUEENS CT
Mailing Address - Street 2:SUITE 101
Mailing Address - City:GERMANTOWN
Mailing Address - State:TN
Mailing Address - Zip Code:38138-3875
Mailing Address - Country:US
Mailing Address - Phone:901-647-5519
Mailing Address - Fax:901-672-7136
Practice Address - Street 1:7503 QUEENS CT
Practice Address - Street 2:SUITE 101
Practice Address - City:GERMANTOWN
Practice Address - State:TN
Practice Address - Zip Code:38138-3875
Practice Address - Country:US
Practice Address - Phone:901-647-5519
Practice Address - Fax:901-672-7136
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-23
Last Update Date:2010-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist