Provider Demographics
NPI:1720054588
Name:BOLIN, FLORA ELSA (CRNA)
Entity Type:Individual
Prefix:MRS
First Name:FLORA
Middle Name:ELSA
Last Name:BOLIN
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2422 PIONEER BLVD
Mailing Address - Street 2:
Mailing Address - City:GRAND ISLAND
Mailing Address - State:NE
Mailing Address - Zip Code:68801-7342
Mailing Address - Country:US
Mailing Address - Phone:308-382-6024
Mailing Address - Fax:
Practice Address - Street 1:2422 PIONEER BLVD
Practice Address - Street 2:
Practice Address - City:GRAND ISLAND
Practice Address - State:NE
Practice Address - Zip Code:68801-7342
Practice Address - Country:US
Practice Address - Phone:308-382-6024
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-02-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE18638163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse