Healthcare Provider Details

I. General information

NPI: 1801659941
Provider Name (Legal Business Name): MRS. ARMENE METRICE BOLDEN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/01/2024
Last Update Date: 02/01/2024
Certification Date: 02/01/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6854 PARKER RD
FLORISSANT MO
63033-5313
US

IV. Provider business mailing address

6854 PARKER RD
FLORISSANT MO
63033-5313
US

V. Phone/Fax

Practice location:
  • Phone: 314-652-4100
  • Fax: 314-868-2561
Mailing address:
  • Phone: 314-652-4100
  • Fax: 314-868-2561

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP2201X
TaxonomyAmbulatory Care Registered Nurse
License Number2006009185
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: