| NPI | 1386672897 |
|---|---|
| Former Name | DIANA LYNN BOLAND |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: CT 640) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: CT 000640) |
| Enumeration Date | 2006-06-30 |
| Last Update Date | 2014-07-28 |