Provider Demographics
NPI:1669968186
Name:BOLLIGER, JANYNE ROCHELLE (PA)
Entity type:Individual
Prefix:
First Name:JANYNE
Middle Name:ROCHELLE
Last Name:BOLLIGER
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1678 ESKER TRL
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:WI
Mailing Address - Zip Code:53925-9160
Mailing Address - Country:US
Mailing Address - Phone:608-213-5574
Mailing Address - Fax:
Practice Address - Street 1:1678 ESKER TRL
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:WI
Practice Address - Zip Code:53925-9160
Practice Address - Country:US
Practice Address - Phone:608-213-5574
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-09
Last Update Date:2024-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4445-23363AS0400X
WI4445363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical