Provider Demographics
NPI:1447727367
Name:BOLLINGER, LINDSEY RAE (NP)
Entity type:Individual
Prefix:
First Name:LINDSEY
Middle Name:RAE
Last Name:BOLLINGER
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:115 S 7TH ST STE 112
Mailing Address - Street 2:
Mailing Address - City:CANON CITY
Mailing Address - State:CO
Mailing Address - Zip Code:81212-3782
Mailing Address - Country:US
Mailing Address - Phone:719-299-0988
Mailing Address - Fax:719-347-6583
Practice Address - Street 1:115 S 7TH ST STE 112
Practice Address - Street 2:
Practice Address - City:CANON CITY
Practice Address - State:CO
Practice Address - Zip Code:81212-3782
Practice Address - Country:US
Practice Address - Phone:719-299-0988
Practice Address - Fax:719-347-6583
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-29
Last Update Date:2024-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COAPN.0994257-NP363LF0000X, 363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute CareGroup - Single Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty