Individual
MRS. CANDICE M BOLLING
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
P.A.-C
Contact information
Practice address
16431 WISE ST, SAINT PAUL, VA 24283-3537
(276) 762-2300
(276) 762-0612
Mailing address
1021 W OAKLAND AVE STE 310, JOHNSON CITY, TN 37604-2192
(423) 302-6565
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
0110002673
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1477736684
—
VA
01
—
P01376909
RR MEDICARE
VA
Enumeration date
12/11/2007
Last updated
02/26/2024
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