Provider Demographics
NPI:1629497755
Name:BOLLOCK, CLINT ALBERT (MSN, CRNA)
Entity Type:Individual
Prefix:MR
First Name:CLINT
Middle Name:ALBERT
Last Name:BOLLOCK
Suffix:
Gender:M
Credentials:MSN, CRNA
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Other - Credentials:
Mailing Address - Street 1:17245 COLONY DR
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68136-1403
Mailing Address - Country:US
Mailing Address - Phone:402-206-1757
Mailing Address - Fax:507-474-3392
Practice Address - Street 1:2808 S 143RD PLZ
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68144-5611
Practice Address - Country:US
Practice Address - Phone:402-609-1485
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-04-16
Last Update Date:2022-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE101417367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered