Provider Demographics
NPI:1407815814
Name:BOLING, LINDA D (CRNA)
Entity Type:Individual
Prefix:
First Name:LINDA
Middle Name:D
Last Name:BOLING
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:501 MOUNTAINBROOK RD
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:SC
Mailing Address - Zip Code:29720-1729
Mailing Address - Country:US
Mailing Address - Phone:803-286-1163
Mailing Address - Fax:803-416-8351
Practice Address - Street 1:800 W MEETING ST
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:SC
Practice Address - Zip Code:29720-2202
Practice Address - Country:US
Practice Address - Phone:803-286-1452
Practice Address - Fax:803-416-8352
Is Sole Proprietor?:No
Enumeration Date:2006-03-23
Last Update Date:2016-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC31708367500000X
SC668367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCAN0262Medicaid
SCAN0262Medicaid
Q27634Medicare ID - Type Unspecified