Provider Demographics
NPI:1114813151
Name:BOLLING, PHILIP
Entity type:Individual
Prefix:
First Name:PHILIP
Middle Name:
Last Name:BOLLING
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4128 RED FOX LN
Mailing Address - Street 2:
Mailing Address - City:FORT CALHOUN
Mailing Address - State:NE
Mailing Address - Zip Code:68023-5272
Mailing Address - Country:US
Mailing Address - Phone:402-312-7412
Mailing Address - Fax:
Practice Address - Street 1:4128 RED FOX LN
Practice Address - Street 2:
Practice Address - City:FORT CALHOUN
Practice Address - State:NE
Practice Address - Zip Code:68023-5272
Practice Address - Country:US
Practice Address - Phone:402-312-7412
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-06-16
Last Update Date:2025-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes372600000XNursing Service Related ProvidersAdult Companion