=====================================================
General NPI Number Information
=====================================================
NPI Number | 1952541989
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | BARBARA A BOLIA L.P.N.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/04/2009
-----------------------------------------------------
Last Update Date | 03/04/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5895 BATSFORD DR
-----------------------------------------------------
City | DAYTON
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 45459-1456
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 937-433-6883
-----------------------------------------------------
Fax | 937-433-6883
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 355
-----------------------------------------------------
City | NEW CARLISLE
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 45344-0355
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 937-242-6391
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 164W00000X
-----------------------------------------------------
Taxonomy Name | Licensed Practical Nurse
-----------------------------------------------------
License Number | PN046943
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------