Provider Demographics
NPI:1417935040
Name:BOLLMANN, CARRIE JEAN-BOROWSKI (FNP-C)
Entity Type:Individual
Prefix:MRS
First Name:CARRIE
Middle Name:JEAN-BOROWSKI
Last Name:BOLLMANN
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1249 M-75 SOUTH
Mailing Address - Street 2:
Mailing Address - City:BOYNE CITY
Mailing Address - State:MI
Mailing Address - Zip Code:49712
Mailing Address - Country:US
Mailing Address - Phone:231-582-1515
Mailing Address - Fax:231-582-2425
Practice Address - Street 1:1249 M-75 SOUTH
Practice Address - Street 2:
Practice Address - City:BOYNE CITY
Practice Address - State:MI
Practice Address - Zip Code:49712
Practice Address - Country:US
Practice Address - Phone:231-582-1515
Practice Address - Fax:231-582-2425
Is Sole Proprietor?:No
Enumeration Date:2006-01-04
Last Update Date:2018-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704177269363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIQ02582Medicare UPIN