Healthcare Provider Details

I. General information

NPI: 1003306838
Provider Name (Legal Business Name): ELIZABETH ANN BOLIG RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

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

III. Provider practice location address

4203 HOSPITAL RD
COAL TOWNSHIP PA
17866-9668
US

IV. Provider business mailing address

4203 HOSPITAL RD
COAL TOWNSHIP PA
17866-9668
US

V. Phone/Fax

Practice location:
  • Phone: 570-648-4010
  • Fax: 570-648-5076
Mailing address:
  • Phone: 570-648-4010
  • Fax: 570-648-5076

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WW0101X
TaxonomyAmbulatory Women's Health Care Registered Nurse
License NumberRN222588L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: