Kimberley Marie Bolog
Homemaker in Willoughby, OH. Individual provider (NPI-1).
NPI number1902639784
StatusActive
Last updated in NPPESAug 26, 2024
Details
- NPI
- 1902639784
- Entity type
- Individual (NPI-1)
- Name
- Kimberley Marie Bolog
- Sex
- Female
- Sole proprietor
- Yes
- Enumeration date
- Aug 26, 2024
- Certification date
- Aug 26, 2024
- Last updated
- Aug 26, 2024
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 376J00000X | Homemaker | – | – | Yes |
Practice location
1054 Cherokee TrlWilloughby, OH 44094-7211
Phone 440-226-6114
Mailing address
1054 Cherokee TrlWilloughby, OH 44094-7211
Phone 440-226-6114
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