Provider Demographics
NPI:1407097397
Name:BOLLINGER, EVELYN (RN)
Entity Type:Individual
Prefix:
First Name:EVELYN
Middle Name:
Last Name:BOLLINGER
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:ONE INGALLS DRIVE
Mailing Address - Street 2:INGALLS HOME CARE
Mailing Address - City:HARVEY
Mailing Address - State:IL
Mailing Address - Zip Code:60426-3591
Mailing Address - Country:US
Mailing Address - Phone:708-331-0226
Mailing Address - Fax:708-915-6357
Practice Address - Street 1:INGALLS HOME CARE
Practice Address - Street 2:ONE INGALLS DRIVE
Practice Address - City:HARVEY
Practice Address - State:IL
Practice Address - Zip Code:60426-3591
Practice Address - Country:US
Practice Address - Phone:708-331-0226
Practice Address - Fax:708-915-6357
Is Sole Proprietor?:No
Enumeration Date:2009-03-23
Last Update Date:2009-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209.007117364S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364S00000XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse Specialist