Provider Demographics
NPI:1891367702
Name:BOLLECH, KAYLA M (RN)
Entity Type:Individual
Prefix:
First Name:KAYLA
Middle Name:M
Last Name:BOLLECH
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:KAYLA
Other - Middle Name:M
Other - Last Name:LAFRENIERE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:PO BOX 22487
Mailing Address - Street 2:
Mailing Address - City:GREEN BAY
Mailing Address - State:WI
Mailing Address - Zip Code:54305-2487
Mailing Address - Country:US
Mailing Address - Phone:920-445-7222
Mailing Address - Fax:920-445-7289
Practice Address - Street 1:744 S WEBSTER AVE
Practice Address - Street 2:
Practice Address - City:GREEN BAY
Practice Address - State:WI
Practice Address - Zip Code:54301-3505
Practice Address - Country:US
Practice Address - Phone:920-433-3500
Practice Address - Fax:920-445-7301
Is Sole Proprietor?:No
Enumeration Date:2021-07-12
Last Update Date:2021-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI172555-30163W00000X
WI11360-33363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
F03210537OtherAMERICAN ACADEMY OF NURSE PRACTITIONERS