Healthcare Provider Details

I. General information

NPI: 1265289003
Provider Name (Legal Business Name): CARMELA MARIE BOLLER APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/30/2024
Last Update Date: 12/15/2025
Certification Date: 12/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

325 MAINE ST
LAWRENCE KS
66044-1360
US

IV. Provider business mailing address

325 MAINE STREET MSO LIBRARY
LAWRENCE KS
66044
US

V. Phone/Fax

Practice location:
  • Phone: 785-505-5775
  • Fax:
Mailing address:
  • Phone: 785-505-2988
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number53-83128-031
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: