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General NPI Number Information
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NPI Number | 1285456640
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Entity Type | Organization
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Legal Business Name | BOLD BEGINNINGS WELLNESS
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Dates
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Enumeration Date | 10/28/2024
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Last Update Date | 03/06/2025
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Provider Practice Location Address
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Address Line | 8087 CINCINNATI DAYTON RD STE A
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City | WEST CHESTER
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State | OH
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Zip | 45069-2003
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Country | US
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Telephone | 937-527-6239
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Fax |
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Provider Business Mailing Address
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Address Line | 10948 STATE ROUTE 73
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City | NEW VIENNA
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State | OH
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Zip | 45159-9524
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Country | US
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Telephone | 937-527-6239
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | MRS. CHEYENNE M GASAWAY
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Credential | APRN, BCADM
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Telephone | 937-527-6239
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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