MEDICARE: SCOTT MICHAEL BOLINGER

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	164W00000X	Licensed Practical Nurse	822942	NV

General Provider Information

NPI Number	:	1578333068
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SCOTT MICHAEL BOLINGER

Provider Business Mailing Address
First Line	:	9049 FAVERSHAM CT
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89123-3023
Country	:	US
Telephone Number	:	972-951-1674
Fax Number	:

Provider Business Practice Location Address
First Line	:	9049 FAVERSHAM CT
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89123-3023
Country	:	US
Telephone Number	:	972-951-1674
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/04/2024
Last Update Date	:	01/04/2024

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Directions to “ SCOTT MICHAEL BOLINGER ” Practice Location

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