Provider Demographics
NPI:1417038621
Name:BOLLIER, ELLEN (RN, CS)
Entity Type:Individual
Prefix:
First Name:ELLEN
Middle Name:
Last Name:BOLLIER
Suffix:
Gender:F
Credentials:RN, CS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:129 KING ST
Mailing Address - Street 2:
Mailing Address - City:NORTHAMPTON
Mailing Address - State:MA
Mailing Address - Zip Code:01060-3258
Mailing Address - Country:US
Mailing Address - Phone:413-584-6855
Mailing Address - Fax:
Practice Address - Street 1:495 WEST ST UNIT 1A
Practice Address - Street 2:
Practice Address - City:AMHERST
Practice Address - State:MA
Practice Address - Zip Code:01002-3379
Practice Address - Country:US
Practice Address - Phone:413-687-1975
Practice Address - Fax:413-259-9190
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-17
Last Update Date:2015-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA210882163WP0809X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0809XNursing Service ProvidersRegistered NursePsychiatric/Mental Health, Adult
Provider Identifiers
StateIdentifier IDID TypeIssuer
MANS0066Medicare ID - Type Unspecified