Provider Demographics
NPI:1871930115
Name:BOLNICK, ALISON W (RN)
Entity type:Individual
Prefix:MS
First Name:ALISON
Middle Name:W
Last Name:BOLNICK
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:113 TWELVE OAKS DR
Mailing Address - Street 2:
Mailing Address - City:LAGRANGE
Mailing Address - State:GA
Mailing Address - Zip Code:30241-9647
Mailing Address - Country:US
Mailing Address - Phone:706-302-2691
Mailing Address - Fax:
Practice Address - Street 1:756 WOODBURY HWY
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:GA
Practice Address - Zip Code:30222-1514
Practice Address - Country:US
Practice Address - Phone:706-775-0544
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-05-28
Last Update Date:2013-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN082072163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse