Provider Demographics
NPI:1073196648
Name:BOLDEN, STEPHANIE LASHAE (MSN, DNP, RN)
Entity type:Individual
Prefix:DR
First Name:STEPHANIE
Middle Name:LASHAE
Last Name:BOLDEN
Suffix:
Gender:F
Credentials:MSN, DNP, RN
Other - Prefix:DR
Other - First Name:STEPHANIE
Other - Middle Name:LASHAE
Other - Last Name:BOLDEN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MSN, DNP, RN
Mailing Address - Street 1:1430 OAK CT STE 100
Mailing Address - Street 2:
Mailing Address - City:BEAVERCREEK
Mailing Address - State:OH
Mailing Address - Zip Code:45430-1064
Mailing Address - Country:US
Mailing Address - Phone:937-404-1101
Mailing Address - Fax:
Practice Address - Street 1:3101 BURNET AVE
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45229-3014
Practice Address - Country:US
Practice Address - Phone:513-357-7289
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-03
Last Update Date:2025-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAPRN.CNP.0032681363LF0000X
OHF09220136363LF0000X
OH283570163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty
No163W00000XNursing Service ProvidersRegistered Nurse