Provider Demographics
NPI:1356681951
Name:BOLIN, AMBER E
Entity type:Individual
Prefix:
First Name:AMBER
Middle Name:E
Last Name:BOLIN
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 1:3983 CLOVERDALE RD
Mailing Address - Street 2:
Mailing Address - City:MEDWAY
Mailing Address - State:OH
Mailing Address - Zip Code:45341-8726
Mailing Address - Country:US
Mailing Address - Phone:937-207-5590
Mailing Address - Fax:
Practice Address - Street 1:3983 CLOVERDALE RD
Practice Address - Street 2:
Practice Address - City:MEDWAY
Practice Address - State:OH
Practice Address - Zip Code:45341-8726
Practice Address - Country:US
Practice Address - Phone:937-207-5590
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-20
Last Update Date:2013-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator