Provider Demographics
NPI:1982207973
Name:BOLL, LAUREN (RN)
Entity Type:Individual
Prefix:
First Name:LAUREN
Middle Name:
Last Name:BOLL
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5610 S 42ND ST
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68107-3103
Mailing Address - Country:US
Mailing Address - Phone:531-299-1481
Mailing Address - Fax:531-502-3449
Practice Address - Street 1:5610 S 42ND ST
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68107-3103
Practice Address - Country:US
Practice Address - Phone:531-299-1481
Practice Address - Fax:531-502-3449
Is Sole Proprietor?:No
Enumeration Date:2020-11-20
Last Update Date:2020-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE88966163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE88966OtherREGISTERED NURSE SCHOOL