Individual
PENNY BOLEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RD, LDN
Contact information
Practice address
1401 E STATE ST, ROCKFORD, IL 61104-2315
(815) 489-4662
(815) 961-2438
Mailing address
6623 VALLEY TRAIL RD, ROCKFORD, IL 61109-4599
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
164.001351
IL
Other
Enumeration date
07/06/2011
Last updated
07/06/2011
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