Provider Demographics
NPI:1538500939
Name:BOLGER, BRIE DANIELLE (FNP)
Entity Type:Individual
Prefix:MS
First Name:BRIE
Middle Name:DANIELLE
Last Name:BOLGER
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:969 RUE MADORA
Mailing Address - Street 2:
Mailing Address - City:BEAR
Mailing Address - State:DE
Mailing Address - Zip Code:19701-2576
Mailing Address - Country:US
Mailing Address - Phone:302-668-8268
Mailing Address - Fax:
Practice Address - Street 1:969 RUE MADORA
Practice Address - Street 2:
Practice Address - City:BEAR
Practice Address - State:DE
Practice Address - Zip Code:19701-2576
Practice Address - Country:US
Practice Address - Phone:302-668-8268
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-07-13
Last Update Date:2015-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP012964363LP2300X, 363LF0000X
DELG-0000714363LP2300X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily