Provider Demographics
NPI:1477571347
Name:BOLYANATZ, PAMELA (RN, MSN, APRN, BC)
Entity Type:Individual
Prefix:MS
First Name:PAMELA
Middle Name:
Last Name:BOLYANATZ
Suffix:
Gender:F
Credentials:RN, MSN, APRN, BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3333 CALIFORNIA ST
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94118-1981
Mailing Address - Country:US
Mailing Address - Phone:630-319-1962
Mailing Address - Fax:
Practice Address - Street 1:3035 BOOK RD
Practice Address - Street 2:
Practice Address - City:NAPERVILLE
Practice Address - State:IL
Practice Address - Zip Code:60564-4715
Practice Address - Country:US
Practice Address - Phone:630-319-1962
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-18
Last Update Date:2019-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209-005489363LF0000X
CA306471207RX0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty
No207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical OncologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL214217Medicare PIN