| Doctor Name: | MRS. JACQUELINE BOLMER |
| NPI Number: | 1619236908 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | NP-C |
| License Number: | COA.13279-NP |
| Business Practice Address: | 210 Sterling Run Blvd Mount Orab, OH - 451548350 |
| Business Phone Number: | 6154254200 |
| Business Fax Number: | |
| Mailing Address: | 2620 Elm Hill Pike, NASHVILLE |
| State: | TN |
| Postal Code: | 372143108 |
| Phone Number: | 6154254200 |
| Fax Number: | 6154254268 |
| NPI Enumeration Date: | 05/08/2012 |
| NPI Last Update Date: | 05/08/2012 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LF0000X |
| License Number: | COA.13279-NP |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | OH |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Family |
| Taxonomy Definition: | |