Provider Demographics
NPI:1841946118
Name:BOLAND, AISHA (LPN/LVN)
Entity type:Individual
Prefix:
First Name:AISHA
Middle Name:
Last Name:BOLAND
Suffix:
Gender:F
Credentials:LPN/LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2201 ROCKBROOK DR APT 724
Mailing Address - Street 2:
Mailing Address - City:LEWISVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75067-3818
Mailing Address - Country:US
Mailing Address - Phone:214-995-4628
Mailing Address - Fax:
Practice Address - Street 1:2201 ROCKBROOK DR APT 724
Practice Address - Street 2:
Practice Address - City:LEWISVILLE
Practice Address - State:TX
Practice Address - Zip Code:75067-3818
Practice Address - Country:US
Practice Address - Phone:214-995-4628
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-25
Last Update Date:2022-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1032966164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1032966OtherBON