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General NPI Number Information
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NPI Number | 1689677213
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Entity Type | Individual
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Provider Name | KATHIE E BOLLENBACH M.M.S., P.A.-C
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Gender | Female
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Dates
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Enumeration Date | 05/27/2005
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Last Update Date | 04/04/2025
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Provider Practice Location Address
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Address Line | 9500 NC HIGHWAY 94 N
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City | CRESWELL
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State | NC
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Zip | 27928-8300
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Country | US
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Telephone | 252-209-0237
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Fax | 252-209-0197
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Provider Business Mailing Address
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Address Line | PO BOX 669
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City | AHOSKIE
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State | NC
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Zip | 27910-0669
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Country | US
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Telephone | 252-209-0237
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Fax | 252-209-0197
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 1233-023
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License Number State | WI
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Taxonomy #2
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | MA066417
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License Number State | PA
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