Provider Demographics
NPI:1497050546
Name:BOLL, ANDREA HELENE (RN)
Entity Type:Individual
Prefix:MS
First Name:ANDREA
Middle Name:HELENE
Last Name:BOLL
Suffix:
Gender:F
Credentials:RN
Other - Prefix:MS
Other - First Name:ANDREA
Other - Middle Name:HELENE
Other - Last Name:JANICKI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:12700 GREEN MEADOW PL
Mailing Address - Street 2:
Mailing Address - City:ELM GROVE
Mailing Address - State:WI
Mailing Address - Zip Code:53122-1937
Mailing Address - Country:US
Mailing Address - Phone:414-640-2321
Mailing Address - Fax:
Practice Address - Street 1:12700 GREEN MEADOW PL
Practice Address - Street 2:
Practice Address - City:ELM GROVE
Practice Address - State:WI
Practice Address - Zip Code:53122-1937
Practice Address - Country:US
Practice Address - Phone:414-640-2321
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-21
Last Update Date:2011-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI153108-30163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse