Provider Demographics
NPI:1336747807
Name:BOLLING, JANA (APRN)
Entity Type:Individual
Prefix:
First Name:JANA
Middle Name:
Last Name:BOLLING
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1149 W CHESTNUT RD
Mailing Address - Street 2:
Mailing Address - City:GOLDSBY
Mailing Address - State:OK
Mailing Address - Zip Code:73093-9156
Mailing Address - Country:US
Mailing Address - Phone:405-408-0739
Mailing Address - Fax:
Practice Address - Street 1:3280 MARSHALL AVE
Practice Address - Street 2:
Practice Address - City:NORMAN
Practice Address - State:OK
Practice Address - Zip Code:73072-8022
Practice Address - Country:US
Practice Address - Phone:405-579-5858
Practice Address - Fax:405-292-1787
Is Sole Proprietor?:No
Enumeration Date:2020-10-15
Last Update Date:2020-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKF06200601363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily