Basic Information
| Provider Information | |||||||||
| NPI: | 1710483839 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BOLDING | ||||||||
| FirstName: | KATHLEEN | ||||||||
| MiddleName: | FOWLER | ||||||||
| NamePrefix: | MRS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | RN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2940 INLAND EMPIRE BLVD | ||||||||
| Address2: | |||||||||
| City: | ONTARIO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 917644898 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 2940 INLAND EMPIRE BLVD | ||||||||
| Address2: | |||||||||
| City: | ONTARIO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 917644898 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9094581350 | ||||||||
| FaxNumber: | 9095798149 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/05/2018 | ||||||||
| LastUpdateDate: | 04/05/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163WA2000X | 850337 | CA | N | Nursing Service Providers | Registered Nurse | Administrator | 163W00000X | 850337 | CA | Y | Nursing Service Providers | Registered Nurse |
No ID Information.