Provider Demographics
NPI:1912452863
Name:BOLL, LINDSAY
Entity Type:Individual
Prefix:
First Name:LINDSAY
Middle Name:
Last Name:BOLL
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 1:155 ROCHDALE DR S STE A
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48309-2276
Mailing Address - Country:US
Mailing Address - Phone:248-608-0360
Mailing Address - Fax:246-608-0362
Practice Address - Street 1:155 ROCHDALE DR S STE A
Practice Address - Street 2:
Practice Address - City:ROCHESTER HILLS
Practice Address - State:MI
Practice Address - Zip Code:48309-2276
Practice Address - Country:US
Practice Address - Phone:248-608-0360
Practice Address - Fax:248-608-0362
Is Sole Proprietor?:No
Enumeration Date:2016-08-22
Last Update Date:2024-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5601007894363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant