Healthcare Provider Details

I. General information

NPI: 1306433602
Provider Name (Legal Business Name): JUSTINE BOLLINGER FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/22/2020
Last Update Date: 12/22/2020
Certification Date: 12/21/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2939 S SHERIDAN RD
STANTON MI
48888-9285
US

IV. Provider business mailing address

1183 S HILLMAN RD
STANTON MI
48888-9151
US

V. Phone/Fax

Practice location:
  • Phone: 989-831-9009
  • Fax:
Mailing address:
  • Phone: 616-894-0353
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number4704269625
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: