Healthcare Provider Details

I. General information

NPI: 1447448279
Provider Name (Legal Business Name): REBECCA LYNN BOLLING NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/05/2007
Last Update Date: 02/12/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2620 E BARNETT RD SUITE H
MEDFORD OR
97504-8344
US

IV. Provider business mailing address

560 CATALINA DR
ASHLAND OR
97520-1605
US

V. Phone/Fax

Practice location:
  • Phone: 541-789-4281
  • Fax: 541-789-2558
Mailing address:
  • Phone: 541-201-4930
  • Fax: 541-201-4931

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number327
License Number StateAK
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number200850001NP
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: