Provider Demographics
NPI:1619557832
Name:BOLAND-BRYANT, KEEMA PETRIA (CRNP)
Entity Type:Individual
Prefix:
First Name:KEEMA
Middle Name:PETRIA
Last Name:BOLAND-BRYANT
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:KEEMA
Other - Middle Name:
Other - Last Name:BOLAND
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:29373 NETWORK PL
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60673-4663
Mailing Address - Country:US
Mailing Address - Phone:847-390-5900
Mailing Address - Fax:
Practice Address - Street 1:4400 W 95TH ST STE 310
Practice Address - Street 2:
Practice Address - City:OAK LAWN
Practice Address - State:IL
Practice Address - Zip Code:60453-2660
Practice Address - Country:US
Practice Address - Phone:708-684-9230
Practice Address - Fax:708-684-9231
Is Sole Proprietor?:No
Enumeration Date:2021-04-12
Last Update Date:2023-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209-027481363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily