Provider Demographics
NPI:1003432873
Name:BOLES, ERIN
Entity Type:Individual
Prefix:
First Name:ERIN
Middle Name:
Last Name:BOLES
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 1:1600 E DESERT INN RD STE 104
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89169-2505
Mailing Address - Country:US
Mailing Address - Phone:702-208-2194
Mailing Address - Fax:702-208-2208
Practice Address - Street 1:1600 E DESERT INN RD
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89169-2525
Practice Address - Country:US
Practice Address - Phone:702-208-2194
Practice Address - Fax:702-208-2208
Is Sole Proprietor?:No
Enumeration Date:2020-06-17
Last Update Date:2020-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV172A00000X
374700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374700000XNursing Service Related ProvidersTechnician
No172A00000XOther Service ProvidersDriver