Healthcare Provider Details

I. General information

NPI: 1003432873
Provider Name (Legal Business Name): ERIN BOLES
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/17/2020
Last Update Date: 06/17/2020
Certification Date: 06/17/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 E DESERT INN RD
LAS VEGAS NV
89169-2525
US

IV. Provider business mailing address

1600 E DESERT INN RD STE 104
LAS VEGAS NV
89169-2505
US

V. Phone/Fax

Practice location:
  • Phone: 702-208-2194
  • Fax: 702-208-2208
Mailing address:
  • Phone: 702-208-2194
  • Fax: 702-208-2208

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code172A00000X
TaxonomyDriver
License Number
License Number StateNV
# 2
Primary TaxonomyY
Taxonomy Code374700000X
TaxonomyTechnician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: