Provider Demographics
NPI:1033072582
Name:BOLLINGER, JADE (APRN)
Entity type:Individual
Prefix:
First Name:JADE
Middle Name:
Last Name:BOLLINGER
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:176 W MOUND RD
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:IL
Mailing Address - Zip Code:62526-1964
Mailing Address - Country:US
Mailing Address - Phone:217-875-0163
Mailing Address - Fax:217-875-9007
Practice Address - Street 1:176 W MOUND RD
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:IL
Practice Address - Zip Code:62526-1964
Practice Address - Country:US
Practice Address - Phone:217-875-0163
Practice Address - Fax:217-875-9007
Is Sole Proprietor?:No
Enumeration Date:2025-12-03
Last Update Date:2025-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL041499465163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse