Individual
CHRISTINE MARIE BOLYARD
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
638 STATE ST, OCONOMOWOC, WI 53066-3743
(262) 567-7262
Mailing address
638 STATE ST, OCONOMOWOC, WI 53066-3743
(262) 567-7262
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
26525-3
WI
Other
Enumeration date
04/20/2010
Last updated
04/20/2010
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