Provider Demographics
NPI:1053301689
Name:BOLAND, LORNA K
Entity Type:Individual
Prefix:MRS
First Name:LORNA
Middle Name:K
Last Name:BOLAND
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:670 COUNTY ROAD 83
Mailing Address - Street 2:P.O. BOX 322
Mailing Address - City:CANBY
Mailing Address - State:CA
Mailing Address - Zip Code:96015-9722
Mailing Address - Country:US
Mailing Address - Phone:530-233-4641
Mailing Address - Fax:530-233-4140
Practice Address - Street 1:670 COUNTY ROAD 83
Practice Address - Street 2:
Practice Address - City:CANBY
Practice Address - State:CA
Practice Address - Zip Code:96015-9722
Practice Address - Country:US
Practice Address - Phone:530-233-4641
Practice Address - Fax:530-233-4140
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA529500163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse