Provider Demographics
NPI:1912045360
Name:BOLIVAR, JANICE RODGERS (RN,CARN)
Entity Type:Individual
Prefix:MRS
First Name:JANICE
Middle Name:RODGERS
Last Name:BOLIVAR
Suffix:
Gender:F
Credentials:RN,CARN
Other - Prefix:
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Mailing Address - Street 1:113 KINCAID CT
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70508-8029
Mailing Address - Country:US
Mailing Address - Phone:337-857-2008
Mailing Address - Fax:337-262-1272
Practice Address - Street 1:302 DULLES DR
Practice Address - Street 2:SUITE 1
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70506-3008
Practice Address - Country:US
Practice Address - Phone:337-262-5870
Practice Address - Fax:337-262-1272
Is Sole Proprietor?:No
Enumeration Date:2007-02-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA35367163W00000X
LA3852163WA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered163W00000XNursing Service ProvidersRegistered Nurse
Not Answered163WA0400XNursing Service ProvidersRegistered NurseAddiction (Substance Use Disorder)