MEDICARE: PLB NURSING SOLUTIONS PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	253Z00000X	In Home Supportive Care Agency
2	261QH0100X	Health Service Clinic/Center
3	364SH0200X	Home Health Clinical Nurse Specialist
4	251J00000X	Nursing Care Agency

General Provider Information

NPI Number	:	1851870695
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PLB NURSING SOLUTIONS PLLC

Provider Business Mailing Address
First Line	:	3020 PROSPERITY CHURCH RD STE I
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28269-8100
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3020 PROSPERITY CHURCH RD STE I
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28269-8100
Country	:	US
Telephone Number	:	980-295-2204
Fax Number	:

Authorized Official
Title or Position	:	FAMILY NURSE PRACTITIONER
Name	:	PHALAN LARESE BOLDEN
Credential	:	NP
Telephone Number	:	413-265-9654

Provider Enumeration Date	:	08/13/2018
Last Update Date	:	08/13/2018

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