Provider Demographics
NPI:1669022844
Name:BOLDEN, DAVINA GLORITA
Entity Type:Individual
Prefix:
First Name:DAVINA
Middle Name:GLORITA
Last Name:BOLDEN
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 1:6901 DETROIT AVE APT 3
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44102-3055
Mailing Address - Country:US
Mailing Address - Phone:216-450-8548
Mailing Address - Fax:
Practice Address - Street 1:6901 DETROIT AVE APT 3
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44102-3055
Practice Address - Country:US
Practice Address - Phone:216-450-8548
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-18
Last Update Date:2019-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide