MEDICARE: BRENDA BOLLINGER N.P.

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	163W00000X	Registered Nurse	809870	CA
2	363LA2200X	Adult Health Nurse Practitioner	23660	CA

General Provider Information

NPI Number	:	1639507411
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRENDA BOLLINGER N.P.

Provider Business Mailing Address
First Line	:	3110 W LAKE CENTER DR
Second Line	:
City	:	SANTA ANA
State	:	CA
Zip	:	92704-6917
Country	:	US
Telephone Number	:	714-513-6630
Fax Number	:

Provider Business Practice Location Address
First Line	:	3110 W LAKE CENTER DR
Second Line	:
City	:	SANTA ANA
State	:	CA
Zip	:	92704-6917
Country	:	US
Telephone Number	:	714-513-6630
Fax Number	:

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

Provider Enumeration Date	:	10/14/2013
Last Update Date	:	09/12/2015

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