Provider Demographics
NPI:1659758688
Name:BOLLE, LAUREN (NP)
Entity Type:Individual
Prefix:MRS
First Name:LAUREN
Middle Name:
Last Name:BOLLE
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1049 SAVANNAH LN
Mailing Address - Street 2:
Mailing Address - City:CALERA
Mailing Address - State:AL
Mailing Address - Zip Code:35040-5406
Mailing Address - Country:US
Mailing Address - Phone:205-612-2651
Mailing Address - Fax:
Practice Address - Street 1:105 COLLIER RD NW
Practice Address - Street 2:SUITE 5020
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30309-1710
Practice Address - Country:US
Practice Address - Phone:404-367-3060
Practice Address - Fax:404-367-3061
Is Sole Proprietor?:No
Enumeration Date:2015-04-28
Last Update Date:2015-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN245938363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care