Provider Demographics
NPI:1932701927
Name:BOLDEN, DIANA PAIGE
Entity Type:Individual
Prefix:
First Name:DIANA
Middle Name:PAIGE
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:PO BOX 515
Mailing Address - Street 2:
Mailing Address - City:DAVY
Mailing Address - State:WV
Mailing Address - Zip Code:24828-0515
Mailing Address - Country:US
Mailing Address - Phone:304-308-4891
Mailing Address - Fax:
Practice Address - Street 1:48 MARION LN
Practice Address - Street 2:
Practice Address - City:MOHEGAN
Practice Address - State:WV
Practice Address - Zip Code:24828
Practice Address - Country:US
Practice Address - Phone:304-308-4891
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-13
Last Update Date:2022-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant