Provider Demographics
NPI:1588874234
Name:BOLLINGER, PATRICIA L (MS, RD)
Entity type:Individual
Prefix:
First Name:PATRICIA
Middle Name:L
Last Name:BOLLINGER
Suffix:
Gender:F
Credentials:MS, RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1733 E. BROADWAY ST
Mailing Address - Street 2:
Mailing Address - City:HELENA
Mailing Address - State:MT
Mailing Address - Zip Code:59601-4609
Mailing Address - Country:US
Mailing Address - Phone:406-443-0134
Mailing Address - Fax:406-443-0134
Practice Address - Street 1:1733 E BROADWAY ST
Practice Address - Street 2:
Practice Address - City:HELENA
Practice Address - State:MT
Practice Address - Zip Code:59601-4609
Practice Address - Country:US
Practice Address - Phone:406-443-0134
Practice Address - Fax:406-443-0134
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-23
Last Update Date:2008-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT117133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT065-1495Medicaid