Provider Demographics
NPI:1326480039
Name:BOLDEN, SHANNON GEHNAI (DNP, WHNP-BC)
Entity Type:Individual
Prefix:DR
First Name:SHANNON
Middle Name:GEHNAI
Last Name:BOLDEN
Suffix:
Gender:F
Credentials:DNP, WHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9308 CHERRY HILL RD APT 220
Mailing Address - Street 2:
Mailing Address - City:COLLEGE PARK
Mailing Address - State:MD
Mailing Address - Zip Code:20740-1233
Mailing Address - Country:US
Mailing Address - Phone:410-369-8994
Mailing Address - Fax:
Practice Address - Street 1:9308 CHERRY HILL RD APT 220
Practice Address - Street 2:
Practice Address - City:COLLEGE PARK
Practice Address - State:MD
Practice Address - Zip Code:20740-1233
Practice Address - Country:US
Practice Address - Phone:410-409-8206
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-07-23
Last Update Date:2024-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR178324163W00000X, 363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
No163W00000XNursing Service ProvidersRegistered Nurse