Provider Demographics
NPI:1578030102
Name:BOLEY, CYNTHIA (RN, MSN)
Entity type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:
Last Name:BOLEY
Suffix:
Gender:F
Credentials:RN, MSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1720 MONTE VISTA DR
Mailing Address - Street 2:
Mailing Address - City:VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:92084-7122
Mailing Address - Country:US
Mailing Address - Phone:760-726-0410
Mailing Address - Fax:
Practice Address - Street 1:1720 MONTE VISTA DR
Practice Address - Street 2:
Practice Address - City:VISTA
Practice Address - State:CA
Practice Address - Zip Code:92084-7122
Practice Address - Country:US
Practice Address - Phone:760-726-0410
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-11-01
Last Update Date:2018-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA762642163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse