Individual
ELIZABETH BOLANOS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
APN
Contact information
Practice address
4327 S ARCHER AVE, CHICAGO, IL 60632-2844
(773) 242-2370
Mailing address
PO BOX 746721, ATLANTA, GA 30374-6721
(312) 733-9730
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
209016790
IL
Other
Enumeration date
01/23/2018
Last updated
05/04/2021
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