Healthcare Provider Details

I. General information

NPI: 1851870695
Provider Name (Legal Business Name): PLB NURSING SOLUTIONS PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/13/2018
Last Update Date: 08/13/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3020 PROSPERITY CHURCH RD STE I
CHARLOTTE NC
28269-8100
US

IV. Provider business mailing address

3020 PROSPERITY CHURCH RD STE I
CHARLOTTE NC
28269-8100
US

V. Phone/Fax

Practice location:
  • Phone: 980-295-2204
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code364SH0200X
TaxonomyHome Health Clinical Nurse Specialist
License Number
License Number State

VIII. Authorized Official

Name: PHALAN LARESE BOLDEN
Title or Position: FAMILY NURSE PRACTITIONER
Credential: NP
Phone: 413-265-9654