Provider Demographics
NPI:1720564180
Name:BOLING, NINA CHELLE (BS, CMA)
Entity Type:Individual
Prefix:
First Name:NINA
Middle Name:CHELLE
Last Name:BOLING
Suffix:
Gender:F
Credentials:BS, CMA
Other - Prefix:
Other - First Name:NINA
Other - Middle Name:CHELLE
Other - Last Name:ACUNA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1457 SERENO DR
Mailing Address - Street 2:
Mailing Address - City:MANTECA
Mailing Address - State:CA
Mailing Address - Zip Code:95337-7000
Mailing Address - Country:US
Mailing Address - Phone:209-456-9379
Mailing Address - Fax:
Practice Address - Street 1:1457 SERENO DR
Practice Address - Street 2:
Practice Address - City:MANTECA
Practice Address - State:CA
Practice Address - Zip Code:95337-7000
Practice Address - Country:US
Practice Address - Phone:209-456-9379
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-18
Last Update Date:2018-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician