Provider Demographics
NPI:1831905215
Name:BOLANDER, JURRIAAN (LPN)
Entity type:Individual
Prefix:
First Name:JURRIAAN
Middle Name:
Last Name:BOLANDER
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:605 CARTWELL DR
Mailing Address - Street 2:
Mailing Address - City:STAFFORD
Mailing Address - State:VA
Mailing Address - Zip Code:22554-7374
Mailing Address - Country:US
Mailing Address - Phone:571-438-3133
Mailing Address - Fax:
Practice Address - Street 1:605 CARTWELL DR
Practice Address - Street 2:
Practice Address - City:STAFFORD
Practice Address - State:VA
Practice Address - Zip Code:22554-7374
Practice Address - Country:US
Practice Address - Phone:571-438-3133
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-12-10
Last Update Date:2024-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCLPN1005424164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse