Individual
KATHIE E BOLLENBACH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.M.S., P.A.-C
Contact information
Practice address
9500 NC HIGHWAY 94 N, CRESWELL, NC 27928-8300
(252) 209-0237
(252) 209-0197
Mailing address
PO BOX 669, AHOSKIE, NC 27910-0669
(252) 209-0237
(252) 209-0197
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
1233-023
WI
363A00000X
Physician Assistant
MA066417
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
11014110
—
WI
01
—
1851477913
CMH NPI
WI
01
—
390848401050
ANTHEM
WI
Enumeration date
05/27/2005
Last updated
04/04/2025
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