Individual
MS. PATRICIA A BOLLER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RN
Contact information
Practice address
511 PULASKI RD, GREENLAWN, NY 11740-1701
(631) 754-1189
Mailing address
511 PULASKI RD, GREENLAWN, NY 11740-1701
(631) 754-1189
Taxonomy
Speciality
Code
Description
License number
State
163WG0000X
General Practice Registered Nurse
Primary
378-172-1
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
01782287
—
NY
Enumeration date
05/18/2007
Last updated
07/09/2007
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