Provider Demographics
NPI:1861944753
Name:BOLL, MARCIA LYNNE (CNP)
Entity type:Individual
Prefix:
First Name:MARCIA
Middle Name:LYNNE
Last Name:BOLL
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:MARCIA
Other - Middle Name:LYNNE
Other - Last Name:DALLY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:8399 72ND ST SW
Mailing Address - Street 2:
Mailing Address - City:HOWARD LAKE
Mailing Address - State:MN
Mailing Address - Zip Code:55349-5412
Mailing Address - Country:US
Mailing Address - Phone:612-314-0418
Mailing Address - Fax:
Practice Address - Street 1:8399 72ND ST SW
Practice Address - Street 2:
Practice Address - City:HOWARD LAKE
Practice Address - State:MN
Practice Address - Zip Code:55349-5412
Practice Address - Country:US
Practice Address - Phone:612-314-0418
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-10-26
Last Update Date:2024-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN4816363LF0000X
MNR-124514-9363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily