Provider Demographics
NPI:1992471973
Name:BOLL, MEGHAN (APNP)
Entity type:Individual
Prefix:
First Name:MEGHAN
Middle Name:
Last Name:BOLL
Suffix:
Gender:F
Credentials:APNP
Other - Prefix:
Other - First Name:MEGHAN
Other - Middle Name:
Other - Last Name:PASINEAU
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:212 GORDON ST
Mailing Address - Street 2:
Mailing Address - City:SAINT CLOUD
Mailing Address - State:WI
Mailing Address - Zip Code:53079-1458
Mailing Address - Country:US
Mailing Address - Phone:920-904-6286
Mailing Address - Fax:
Practice Address - Street 1:2700 W 9TH AVE STE 213
Practice Address - Street 2:
Practice Address - City:OSHKOSH
Practice Address - State:WI
Practice Address - Zip Code:54904-7865
Practice Address - Country:US
Practice Address - Phone:920-831-8900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-19
Last Update Date:2021-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI11229-33363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI11229-33OtherWI STATE LICENSE NUMBER