Provider Demographics
NPI:1659598605
Name:BOLLIER, MARTHA DALE (RN-FNP)
Entity Type:Individual
Prefix:MRS
First Name:MARTHA
Middle Name:DALE
Last Name:BOLLIER
Suffix:
Gender:F
Credentials:RN-FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:202 LANDS END ST
Mailing Address - Street 2:
Mailing Address - City:ROCKPORT
Mailing Address - State:TX
Mailing Address - Zip Code:78382-9769
Mailing Address - Country:US
Mailing Address - Phone:361-386-0166
Mailing Address - Fax:
Practice Address - Street 1:4430 E 14TH ST STE A
Practice Address - Street 2:
Practice Address - City:BROWNSVILLE
Practice Address - State:TX
Practice Address - Zip Code:78521-3240
Practice Address - Country:US
Practice Address - Phone:956-544-5557
Practice Address - Fax:956-544-5100
Is Sole Proprietor?:No
Enumeration Date:2007-04-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX593673363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily