Provider Demographics
NPI:1205686094
Name:BOLAND, SARA EMMA (RN)
Entity type:Individual
Prefix:
First Name:SARA
Middle Name:EMMA
Last Name:BOLAND
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 1:3624 E MORNINGSIDE DR
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:IN
Mailing Address - Zip Code:47408-4334
Mailing Address - Country:US
Mailing Address - Phone:623-552-0375
Mailing Address - Fax:
Practice Address - Street 1:1302 S ROGERS ST
Practice Address - Street 2:
Practice Address - City:BLOOMINGTON
Practice Address - State:IN
Practice Address - Zip Code:47403-4752
Practice Address - Country:US
Practice Address - Phone:812-353-3700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-25
Last Update Date:2024-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN28243535A163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse