Provider Demographics
NPI:1700313525
Name:BOLDEN, AMIRA
Entity type:Individual
Prefix:
First Name:AMIRA
Middle Name:
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 1:607 SW HIGGINS AVE
Mailing Address - Street 2:607 SW HIGGINS
Mailing Address - City:MISSOULA
Mailing Address - State:MT
Mailing Address - Zip Code:59803-1468
Mailing Address - Country:US
Mailing Address - Phone:180-046-5320
Mailing Address - Fax:180-069-2232
Practice Address - Street 1:607 SW HIGGINS AVE
Practice Address - Street 2:607 SW HIGGINS
Practice Address - City:MISSOULA
Practice Address - State:MT
Practice Address - Zip Code:59803-1468
Practice Address - Country:US
Practice Address - Phone:184-438-1432
Practice Address - Fax:187-776-3216
Is Sole Proprietor?:No
Enumeration Date:2017-05-11
Last Update Date:2017-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant