Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP0808X | Nurse Practitioner - Psychiatric/Mental Health | RN 124814 | OH |
NPI | 1003016601 |
---|---|
Provider Name | Ms. Darcel Derri Bolser |
First Address | Cincinnati, OH 45220-2213 |
Second Address | Cincinnati, OH 45220-2213 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 20/07/2007 |
Last Update Date | 20/07/2007 |