Doctor Name: | JESSICA K BOLAND |
NPI Number: | 1376815241 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | ARNP |
License Number: | SP013976 |
Business Practice Address: | 1181 Freedom Rd Cranberry Township, PA - 160664913 |
Business Phone Number: | 4077583025 |
Business Fax Number: | |
Mailing Address: | 2523 Bonnie Dell Dr, SOUTH PARK |
State: | PA |
Postal Code: | 151298898 |
Phone Number: | 4077583025 |
Fax Number: | |
NPI Enumeration Date: | 02/07/2012 |
NPI Last Update Date: | 03/23/2015 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363LF0000X |
License Number: | SP013976 |
Healthcare Provider Taxonomy: (Secondary) | N |
State: | PA |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Nurse Practitioner |
Taxonomy Specialization: | Family |
Taxonomy Definition: |