Individual
KRISTA D BOLANGER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
9000 N MAIN ST, SUITE 227, DAYTON, OH 45415-1180
(937) 832-4773
(937) 832-2986
Mailing address
9000 N MAIN ST, SUITE 227, DAYTON, OH 45415-1180
(937) 832-4773
(937) 832-2986
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
50 002179
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0067813
—
OH
Enumeration date
02/01/2007
Last updated
10/23/2018
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