Healthcare Provider Details

I. General information

NPI: 1538471933
Provider Name (Legal Business Name): CYNTHIA DANETTE BOLING LPN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/14/2010
Last Update Date: 07/25/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1005 BALCOM LN
TRUMANN AR
72472-9502
US

IV. Provider business mailing address

2707 BROWNS LANE
JONESBORO AR
72401
US

V. Phone/Fax

Practice location:
  • Phone: 870-483-1461
  • Fax: 870-483-2560
Mailing address:
  • Phone: 870-972-4939
  • Fax: 870-972-4911

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License NumberL27046
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: