Provider Demographics
NPI:1134318702
Name:BOLGER, ANGELA Y (CRNP)
Entity Type:Individual
Prefix:MRS
First Name:ANGELA
Middle Name:Y
Last Name:BOLGER
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:MISS
Other - First Name:ANGELA
Other - Middle Name:Y
Other - Last Name:SAWYER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:121 LANGLEY DR
Mailing Address - Street 2:
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30046-6930
Mailing Address - Country:US
Mailing Address - Phone:770-685-1300
Mailing Address - Fax:770-685-1311
Practice Address - Street 1:121 LANGLEY DR
Practice Address - Street 2:
Practice Address - City:LAWRENCEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30046-6930
Practice Address - Country:US
Practice Address - Phone:770-685-1300
Practice Address - Fax:770-685-1311
Is Sole Proprietor?:No
Enumeration Date:2007-10-19
Last Update Date:2021-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN200066363LA2200X, 363LF0000X
GARN20066363LX0001X
MDR155883363LX0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & Gynecology
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD100819600Medicaid