Provider Demographics
NPI:1336424696
Name:ROCKER, BOLANLE
Entity Type:Individual
Prefix:
First Name:BOLANLE
Middle Name:
Last Name:ROCKER
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 1:8941 N SWAN RD
Mailing Address - Street 2:UNIT E
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53224
Mailing Address - Country:US
Mailing Address - Phone:414-949-0423
Mailing Address - Fax:
Practice Address - Street 1:8941 N SWAN RD
Practice Address - Street 2:UNIT E
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53224-6519
Practice Address - Country:US
Practice Address - Phone:414-949-0423
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-19
Last Update Date:2011-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI309435-31164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse