Individual
BRANDI L BOLLER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DO
Contact information
Practice address
777 NW 9TH ST STE 320, CORVALLIS, OR 97330-6169
(541) 768-1840
Mailing address
815 NW 9TH ST STE 215, CORVALLIS, OR 97330-6173
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
31584
KS
207Q00000X
Family Medicine Physician
Primary
DO203116
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
103827
BLUE CROSS/BLUE SHIELD
KS
Enumeration date
02/27/2006
Last updated
07/19/2022
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