=====================================================
General NPI Number Information
=====================================================
NPI Number | 1548497761
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JOSIE A BOLLIG APRN
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/15/2009
-----------------------------------------------------
Last Update Date | 09/19/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3535 N WEBB RD
-----------------------------------------------------
City | WICHITA
-----------------------------------------------------
State | KS
-----------------------------------------------------
Zip | 67226-8127
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 316-686-5300
-----------------------------------------------------
Fax | 316-651-2660
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3535 N WEBB RD
-----------------------------------------------------
City | WICHITA
-----------------------------------------------------
State | KS
-----------------------------------------------------
Zip | 67226-8127
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 316-686-5300
-----------------------------------------------------
Fax | 316-651-2660
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363L00000X
-----------------------------------------------------
Taxonomy Name | Nurse Practitioner
-----------------------------------------------------
License Number | 3006033
-----------------------------------------------------
License Number State | KY
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number | 53-75671-101
-----------------------------------------------------
License Number State | KS
-----------------------------------------------------