Provider Demographics
NPI:1932430469
Name:BOLLAND, JOANNE ALISE (PHN)
Entity Type:Individual
Prefix:
First Name:JOANNE
Middle Name:ALISE
Last Name:BOLLAND
Suffix:
Gender:F
Credentials:PHN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1805 FORD AVE N STE 200
Mailing Address - Street 2:
Mailing Address - City:GLENCOE
Mailing Address - State:MN
Mailing Address - Zip Code:55336-1371
Mailing Address - Country:US
Mailing Address - Phone:320-864-3185
Mailing Address - Fax:320-864-1484
Practice Address - Street 1:1805 FORD AVE N STE 200
Practice Address - Street 2:
Practice Address - City:GLENCOE
Practice Address - State:MN
Practice Address - Zip Code:55336-1371
Practice Address - Country:US
Practice Address - Phone:320-864-3185
Practice Address - Fax:320-864-1484
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-22
Last Update Date:2010-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNR125812-3163WC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC1500XNursing Service ProvidersRegistered NurseCommunity Health