NPI 1063020816

Precious Laquon Bolden

Practitioner Driver Grand Prairie, TX

Practice location

Address: 1450 N State Highway 360 APT 371, Grand Prairie, TX 75050-4108
Phone: (262) 751-0253

Registered specialties

Driver Primary

Other Service Providers Taxonomy 172A00000X Licence 45590009 (TX)

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Registry record

NPI: 1063020816
Entity type: Individual
Sex (as registered): Female
NPI issued: 17 Jul 2020
Record last updated: 17 Jul 2020

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.