Provider Demographics
NPI:1306040043
Name:BOLDEN, ROSETTA HILL (LPN)
Entity Type:Individual
Prefix:
First Name:ROSETTA
Middle Name:HILL
Last Name:BOLDEN
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 1:3016 ROLLING MEADOWS CT
Mailing Address - Street 2:
Mailing Address - City:LITHONIA
Mailing Address - State:GA
Mailing Address - Zip Code:30038-2240
Mailing Address - Country:US
Mailing Address - Phone:770-987-2718
Mailing Address - Fax:
Practice Address - Street 1:3005 LENORA CHURCH RD STE A
Practice Address - Street 2:
Practice Address - City:SNELLVILLE
Practice Address - State:GA
Practice Address - Zip Code:30078-3688
Practice Address - Country:US
Practice Address - Phone:770-979-9157
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPN143010164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse