Provider Demographics
NPI:1831987239
Name:GROENHAGEN-BOLDEN, DOMINIC EVIN
Entity type:Individual
Prefix:
First Name:DOMINIC
Middle Name:EVIN
Last Name:GROENHAGEN-BOLDEN
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7606 SPRINGFIELD DR
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68114-1611
Mailing Address - Country:US
Mailing Address - Phone:402-690-8045
Mailing Address - Fax:
Practice Address - Street 1:7606 SPRINGFIELD DR
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68114-1611
Practice Address - Country:US
Practice Address - Phone:402-690-8045
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-04-28
Last Update Date:2025-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes372600000XNursing Service Related ProvidersAdult Companion