Provider Demographics
NPI:1003944497
Name:BOLLS, COLLEEN B (PNP)
Entity Type:Individual
Prefix:
First Name:COLLEEN
Middle Name:B
Last Name:BOLLS
Suffix:
Gender:F
Credentials:PNP
Other - Prefix:
Other - First Name:COLLEEN
Other - Middle Name:B
Other - Last Name:BURKE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:2730 6TH ST
Mailing Address - Street 2:
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80304-3232
Mailing Address - Country:US
Mailing Address - Phone:404-895-3603
Mailing Address - Fax:
Practice Address - Street 1:13123 EAST 16TH AVE
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80045
Practice Address - Country:US
Practice Address - Phone:720-777-6888
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-28
Last Update Date:2019-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN177306363LP0200X
CORN191866363LP0200X
COAPN.0010109-NP363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
No363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics