Provider Demographics
NPI:1770936130
Name:BOLUDA, JEANNETTE EPSE
Entity type:Individual
Prefix:
First Name:JEANNETTE
Middle Name:EPSE
Last Name:BOLUDA
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 1:8860 PINEY BRANCH RD
Mailing Address - Street 2:APT 1608
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20903-4865
Mailing Address - Country:US
Mailing Address - Phone:240-505-6246
Mailing Address - Fax:
Practice Address - Street 1:6735 NEW HAMPSHIRE AVE
Practice Address - Street 2:APT 613
Practice Address - City:TAKOMA PARK
Practice Address - State:MD
Practice Address - Zip Code:20912-4865
Practice Address - Country:US
Practice Address - Phone:240-505-6246
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-20
Last Update Date:2018-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCHHA12205374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide