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Individual
SHANNON MARY BOLGER
Active
Individual
SHANNON MARY BOLGER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
ATC
Taxonomy
Speciality
Code
Description
License number
State
390200000X
Student in an Organized Health Care Education/Training Program
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2255A2300X
SPECIALIST/TECHNOLOGIST - ATHLETIC TRAINER
PA
01
—
390200000X
STUDENT IN AN ORGANIZED HEALTH CARE EDUCATION/TRAINING PROGRAM
PA
Enumeration date
04/29/2016
Last updated
04/29/2016
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