Provider Demographics
NPI:1689382210
Name:BOLJONIS, BRIANNE KATHLEEN
Entity Type:Individual
Prefix:
First Name:BRIANNE
Middle Name:KATHLEEN
Last Name:BOLJONIS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6 DOROTHY CT
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:07748-1817
Mailing Address - Country:US
Mailing Address - Phone:540-385-6095
Mailing Address - Fax:
Practice Address - Street 1:6 DOROTHY CT
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:NJ
Practice Address - Zip Code:07748-1817
Practice Address - Country:US
Practice Address - Phone:540-385-6095
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-11-14
Last Update Date:2022-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NR23874900163W00000X
NY689552163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse