Healthcare Provider Details

I. General information

NPI: 1902334741
Provider Name (Legal Business Name): WENDY LEE BOLLING RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/24/2017
Last Update Date: 03/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1100 T ST
NELIGH NE
68756-1027
US

IV. Provider business mailing address

611 E 1ST ST
NELIGH NE
68756-1621
US

V. Phone/Fax

Practice location:
  • Phone: 402-887-5428
  • Fax:
Mailing address:
  • Phone: 402-929-3178
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WH1000X
TaxonomyHospice Registered Nurse
License Number80574
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: