Provider Demographics
NPI:1235457524
Name:BOLGER, STEPHANIE LYN (PA-C)
Entity Type:Individual
Prefix:MS
First Name:STEPHANIE
Middle Name:LYN
Last Name:BOLGER
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Mailing Address - Street 1:225 GRANDVIEW AVE STE 303
Mailing Address - Street 2:
Mailing Address - City:CAMP HILL
Mailing Address - State:PA
Mailing Address - Zip Code:17011-1729
Mailing Address - Country:US
Mailing Address - Phone:717-988-8200
Mailing Address - Fax:717-221-5644
Practice Address - Street 1:225 GRANDVIEW AVE STE 303
Practice Address - Street 2:
Practice Address - City:CAMP HILL
Practice Address - State:PA
Practice Address - Zip Code:17011-1729
Practice Address - Country:US
Practice Address - Phone:717-988-8200
Practice Address - Fax:717-221-5644
Is Sole Proprietor?:No
Enumeration Date:2010-05-11
Last Update Date:2022-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
363AS0400X
PAMA054012363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical