Provider Demographics
NPI:1073196648
Name:BOLDEN, STEPHANIE LASHAE (MSN, DNP, RN)
Entity Type:Individual
Prefix:DR
First Name:STEPHANIE
Middle Name:LASHAE
Last Name:BOLDEN
Suffix:
Gender:F
Credentials:MSN, DNP, RN
Other - Prefix:DR
Other - First Name:STEPHANIE
Other - Middle Name:LASHAE
Other - Last Name:BOLDEN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MSN, DNP, RN
Mailing Address - Street 1:4420 MARBURG AVE APT 308
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45209-1367
Mailing Address - Country:US
Mailing Address - Phone:513-544-3493
Mailing Address - Fax:
Practice Address - Street 1:3101 BURNET AVE
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45229-3014
Practice Address - Country:US
Practice Address - Phone:513-357-7289
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-03
Last Update Date:2022-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH283570163W00000X
OHF09220136363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse