Individual
JOHN BOLLENBACHER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
219 PHYSICIANS PARK, POPLAR BLUFF, MO 63901-3956
(573) 686-5550
Mailing address
2140 AUTUMN RD, POPLAR BLUFF, MO 63901-2703
(573) 686-5550
(573) 686-2139
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
086417
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
184883
BCBS
MO
01
—
P00100713
RAILROAD MEDICARE
MO
Enumeration date
01/11/2006
Last updated
04/04/2008
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