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NPI Code Detail

MEDICARE: JESSICA BOLLMAN

MEDICARE: JESSICA BOLLMAN
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1367500000XCertified Registered Nurse Anesthetist10022075OR
2367500000XCertified Registered Nurse AnesthetistAPRN-CRNA10022075OR
3163W00000XRegistered Nurse448246OH

General Provider Information

NPI Number : 1972360865
Entity Type Code : Individual
Provider Name (Legal Business Name) : JESSICA BOLLMAN
Provider Business Mailing Address
First Line : PO BOX 1189
Second Line :
City : CORVALLIS
State : OR
Zip : 97339-1189
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 1046 6TH AVE SW
Second Line :
City : ALBANY
State : OR
Zip : 97321-1916
Country : US
Telephone Number : 541-812-4000
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/06/2024
Last Update Date : 05/26/2026

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