Provider Demographics
NPI:1649053281
Name:BOLAND, KARLENE NATASHA (FNP)
Entity type:Individual
Prefix:
First Name:KARLENE
Middle Name:NATASHA
Last Name:BOLAND
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:KARLENE
Other - Middle Name:NATASHA
Other - Last Name:HENRIQUES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1152 MAGGIE RD
Mailing Address - Street 2:
Mailing Address - City:NEWBURGH
Mailing Address - State:NY
Mailing Address - Zip Code:12550-7034
Mailing Address - Country:US
Mailing Address - Phone:917-502-3018
Mailing Address - Fax:
Practice Address - Street 1:100 WOODS RD
Practice Address - Street 2:
Practice Address - City:VALHALLA
Practice Address - State:NY
Practice Address - Zip Code:10595-1530
Practice Address - Country:US
Practice Address - Phone:914-493-8680
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-17
Last Update Date:2023-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY352637363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily