Provider Demographics
NPI:1700194859
Name:BOLAND, PATRICIA ANNE (RN)
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:ANNE
Last Name:BOLAND
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:PATRICIA
Other - Middle Name:ANNE
Other - Last Name:ABRAHAMSEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:457 SUMMIT AVE
Mailing Address - Street 2:
Mailing Address - City:CEDARHURST
Mailing Address - State:NY
Mailing Address - Zip Code:11516-1525
Mailing Address - Country:US
Mailing Address - Phone:516-680-4902
Mailing Address - Fax:
Practice Address - Street 1:457 SUMMIT AVE
Practice Address - Street 2:
Practice Address - City:CEDARHURST
Practice Address - State:NY
Practice Address - Zip Code:11516-1525
Practice Address - Country:US
Practice Address - Phone:516-680-4902
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-22
Last Update Date:2010-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY284192-1163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse