Provider Demographics
NPI:1710758297
Name:YODER-BOLLINGER, KIM K
Entity Type:Individual
Prefix:
First Name:KIM
Middle Name:K
Last Name:YODER-BOLLINGER
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 1:309 NEBRASKA DR
Mailing Address - Street 2:
Mailing Address - City:GOSHEN
Mailing Address - State:IN
Mailing Address - Zip Code:46526-1433
Mailing Address - Country:US
Mailing Address - Phone:574-240-4010
Mailing Address - Fax:574-240-0040
Practice Address - Street 1:309 NEBRASKA DR
Practice Address - Street 2:
Practice Address - City:GOSHEN
Practice Address - State:IN
Practice Address - Zip Code:46526-1433
Practice Address - Country:US
Practice Address - Phone:574-240-4010
Practice Address - Fax:574-240-0040
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-12
Last Update Date:2024-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN230153511253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care