Provider Demographics
NPI:1447448279
Name:BOLLING, REBECCA LYNN (NP)
Entity type:Individual
Prefix:MRS
First Name:REBECCA
Middle Name:LYNN
Last Name:BOLLING
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:560 CATALINA DR
Mailing Address - Street 2:
Mailing Address - City:ASHLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97520-1605
Mailing Address - Country:US
Mailing Address - Phone:541-201-4930
Mailing Address - Fax:541-201-4931
Practice Address - Street 1:2620 E BARNETT RD
Practice Address - Street 2:SUITE H
Practice Address - City:MEDFORD
Practice Address - State:OR
Practice Address - Zip Code:97504-8344
Practice Address - Country:US
Practice Address - Phone:541-789-4281
Practice Address - Fax:541-789-2558
Is Sole Proprietor?:No
Enumeration Date:2007-10-05
Last Update Date:2016-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK327363LF0000X
OR200850001NP363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR022868Medicaid
OR20850001NPOtherOREGON LICENSE
AK13995OtherSTATE LICENSE
AK327OtherSTATE LICENSE
OR022868Medicaid