Healthcare Provider Details

I. General information

NPI: 1811540677
Provider Name (Legal Business Name): LISA BOLGAR FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/22/2019
Last Update Date: 07/31/2024
Certification Date: 07/31/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 E LIBERTY ST STE 600
RENO NV
89501-2110
US

IV. Provider business mailing address

1 E LIBERTY ST STE 600
RENO NV
89501-2110
US

V. Phone/Fax

Practice location:
  • Phone: 800-931-5883
  • Fax:
Mailing address:
  • Phone: 800-931-5883
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberC-APN.0003304-C-NP
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number2018043386
License Number StateMO
# 3
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number5012095
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: