1710293576 NPI number — CHRISTINE BOLLIER APN

Table of content: CHRISTINE BOLLIER APN (NPI 1710293576)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1710293576 NPI number — CHRISTINE BOLLIER APN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BOLLIER
Provider First Name:
CHRISTINE
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
APN
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1710293576
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/01/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7 BLANCHARD CIR
Provider Second Line Business Mailing Address:
SUITE 106
Provider Business Mailing Address City Name:
WHEATON
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60189-2037
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
630-668-5985
Provider Business Mailing Address Fax Number:
630-580-7624

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7 BLANCHARD CIR
Provider Second Line Business Practice Location Address:
SUITE 106
Provider Business Practice Location Address City Name:
WHEATON
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60189-2037
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
630-668-5985
Provider Business Practice Location Address Fax Number:
630-580-7624
Provider Enumeration Date:
08/30/2010

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LA2200X , with the licence number:  209008248 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 209008248 , issued by the state of ( IL ) . This identifiers is of the category "MEDICAID".




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