Provider Demographics
NPI:1376671867
Name:BOLLING, LANCE B (RN BSN)
Entity Type:Individual
Prefix:MR
First Name:LANCE
Middle Name:B
Last Name:BOLLING
Suffix:
Gender:M
Credentials:RN BSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:790 WOODLANE RD STE 20
Mailing Address - Street 2:
Mailing Address - City:WESTAMPTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08060-9624
Mailing Address - Country:US
Mailing Address - Phone:609-261-6627
Mailing Address - Fax:609-261-7379
Practice Address - Street 1:790 WOODLANE RD STE 20
Practice Address - Street 2:
Practice Address - City:WESTAMPTON
Practice Address - State:NJ
Practice Address - Zip Code:08060-9624
Practice Address - Country:US
Practice Address - Phone:609-261-6627
Practice Address - Fax:609-261-7379
Is Sole Proprietor?:No
Enumeration Date:2007-02-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NR12035300163WP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ8819700Medicaid