Basic Information
| Provider Information | |||||||||
| NPI: | 1003198029 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BOLLES | ||||||||
| FirstName: | MARCIA | ||||||||
| MiddleName: | ANGELA | ||||||||
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| Credential: | PA-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7954 W OAKBROOK CIR | ||||||||
| Address2: | |||||||||
| City: | MADISON | ||||||||
| State: | WI | ||||||||
| PostalCode: | 537171676 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6088335609 | ||||||||
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| Practice Location | |||||||||
| Address1: | 5249 E TERRACE DR | ||||||||
| Address2: | |||||||||
| City: | MADISON | ||||||||
| State: | WI | ||||||||
| PostalCode: | 537188339 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6082229777 | ||||||||
| FaxNumber: | 6082212646 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/15/2011 | ||||||||
| LastUpdateDate: | 09/15/2011 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363A00000X | 2804-023 | WI | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |
No ID Information.