Provider Demographics
NPI:1306433602
Name:BOLLINGER, JUSTINE (FNP-BC)
Entity type:Individual
Prefix:
First Name:JUSTINE
Middle Name:
Last Name:BOLLINGER
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1183 S HILLMAN RD
Mailing Address - Street 2:
Mailing Address - City:STANTON
Mailing Address - State:MI
Mailing Address - Zip Code:48888-9151
Mailing Address - Country:US
Mailing Address - Phone:616-894-0353
Mailing Address - Fax:
Practice Address - Street 1:2939 S SHERIDAN RD
Practice Address - Street 2:
Practice Address - City:STANTON
Practice Address - State:MI
Practice Address - Zip Code:48888-9285
Practice Address - Country:US
Practice Address - Phone:989-831-9009
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-22
Last Update Date:2020-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704269625363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily