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General NPI Number Information
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NPI Number | 1780840264
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Entity Type | Individual
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Provider Name | SHANNON C BOLINGER PA
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Gender | Female
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Dates
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Enumeration Date | 08/04/2008
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Last Update Date | 05/23/2016
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Provider Practice Location Address
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Address Line | 7609 PRESTON RD STE 3500
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City | PLANO
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State | TX
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Zip | 75024-3214
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Country | US
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Telephone | 469-303-4700
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Fax | 469-303-4230
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Provider Business Mailing Address
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Address Line | PO BOX 398 STE 3500
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City | ANAHUAC
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State | TX
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Zip | 77514-0398
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Country | US
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Telephone | 469-303-4700
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Fax | 469-303-4230
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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 | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | PA05806
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License Number State | TX
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