Provider Demographics
NPI:1558547265
Name:BOLAND, MONA TERESA LYNCH (APN)
Entity Type:Individual
Prefix:
First Name:MONA
Middle Name:TERESA LYNCH
Last Name:BOLAND
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:50 BLANCH AVE
Mailing Address - Street 2:
Mailing Address - City:CLOSTER
Mailing Address - State:NJ
Mailing Address - Zip Code:07624-1228
Mailing Address - Country:US
Mailing Address - Phone:201-784-9400
Mailing Address - Fax:
Practice Address - Street 1:50 BLANCH AVE
Practice Address - Street 2:
Practice Address - City:CLOSTER
Practice Address - State:NJ
Practice Address - Zip Code:07624-1228
Practice Address - Country:US
Practice Address - Phone:201-784-9400
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-11
Last Update Date:2008-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ00111000363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health