| NPI | 1588042915 |
|---|---|
| Former Name | STEPHANIE LYNN BOLLES |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: MN 3904) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| Enumeration Date | 2015-05-18 |
| Last Update Date | 2020-10-06 |