Healthcare Provider Details

I. General information

NPI: 1700689130
Provider Name (Legal Business Name): EFFIE MARIE BOLLMAN IBCLC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/31/2025
Last Update Date: 04/01/2025
Certification Date: 04/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

330 VERMONT ST
QUINCY IL
62301-2700
US

IV. Provider business mailing address

330 VERMONT ST
QUINCY IL
62301-2700
US

V. Phone/Fax

Practice location:
  • Phone: 217-222-8440
  • Fax:
Mailing address:
  • Phone: 217-222-8440
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WC1500X
TaxonomyCommunity Health Registered Nurse
License Number041414425
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number041414425
License Number StateIL
# 3
Primary TaxonomyY
Taxonomy Code163WL0100X
TaxonomyLactation Consultant (Registered Nurse)
License Number041414425
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: