Individual
SUSAN KAY BOLAND
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
P.A.
Contact information
Practice address
300 NORTH WASHINGTON STREET, DARIEN MEDICAL CLINIC, DARIEN, WI 53114-1534
(262) 882-1151
(262) 296-1195
Mailing address
1905 E. HUEBBE PARKWAY, BELOIT HEALTH SYSTEM INC, BELOIT, WI 53511-1842
(608) 364-2200
(608) 363-7395
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
085001543
IL
363A00000X
Physician Assistant
Primary
2122-23
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1023136512
—
WI
Enumeration date
03/26/2007
Last updated
03/08/2011
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