Healthcare Provider Details

I. General information

NPI: 1417460718
Provider Name (Legal Business Name): HANNAH BOLINGER CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/08/2017
Last Update Date: 12/16/2025
Certification Date: 12/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7876 W RIVERSIDE DR
PASADENA MD
21122-3824
US

IV. Provider business mailing address

7876 W RIVERSIDE DR
PASADENA MD
21122-3824
US

V. Phone/Fax

Practice location:
  • Phone: 410-701-0289
  • Fax:
Mailing address:
  • Phone: 410-701-0289
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberR165730
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: