MEDICARE: MARQUEL MONIQUE BOLDEN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	347C00000X	Private Vehicle
2	372600000X	Adult Companion
3	3747P1801X	Personal Care Attendant
4	376J00000X	Homemaker

General Provider Information

NPI Number	:	1194584755
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARQUEL MONIQUE BOLDEN

Provider Business Mailing Address
First Line	:	16001 SHIRLEY AVE
Second Line	:
City	:	MAPLE HEIGHTS
State	:	OH
Zip	:	44137-4616
Country	:	US
Telephone Number	:	216-372-8298
Fax Number	:

Provider Business Practice Location Address
First Line	:	16001 SHIRLEY AVE
Second Line	:
City	:	MAPLE HEIGHTS
State	:	OH
Zip	:	44137-4616
Country	:	US
Telephone Number	:	216-372-8298
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/18/2024
Last Update Date	:	03/25/2024

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Directions to “ MARQUEL MONIQUE BOLDEN ” Practice Location

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