Provider Demographics
NPI:1154417921
Name:BOHLENDER, VICKIE L
Entity type:Individual
Prefix:MS
First Name:VICKIE
Middle Name:L
Last Name:BOHLENDER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2357 AMBER CT
Mailing Address - Street 2:
Mailing Address - City:LOVELAND
Mailing Address - State:CO
Mailing Address - Zip Code:80537-6984
Mailing Address - Country:US
Mailing Address - Phone:970-613-1755
Mailing Address - Fax:970-613-1757
Practice Address - Street 1:2627 REDWING RD
Practice Address - Street 2:SUITE 220A
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80526-6321
Practice Address - Country:US
Practice Address - Phone:970-613-1755
Practice Address - Fax:970-613-1757
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-05
Last Update Date:2009-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO9342281Medicaid
CO9342281Medicaid