Provider Demographics
NPI:1700401288
Name:BOLEK, MEREDITH (RN)
Entity Type:Individual
Prefix:
First Name:MEREDITH
Middle Name:
Last Name:BOLEK
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6565 HUNTING CREEK DR
Mailing Address - Street 2:
Mailing Address - City:LIBERTY TWP
Mailing Address - State:OH
Mailing Address - Zip Code:45044-9545
Mailing Address - Country:US
Mailing Address - Phone:513-464-3214
Mailing Address - Fax:
Practice Address - Street 1:6565 HUNTING CREEK DR
Practice Address - Street 2:
Practice Address - City:LIBERTY TWP
Practice Address - State:OH
Practice Address - Zip Code:45044-9545
Practice Address - Country:US
Practice Address - Phone:513-464-3214
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-10
Last Update Date:2020-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN.317877163WG0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHRM317179OtherDRIVER'S LISCENE