Provider Demographics
NPI:1548032691
Name:BOLGER, PATRICK (RN)
Entity type:Individual
Prefix:
First Name:PATRICK
Middle Name:
Last Name:BOLGER
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16 EMERALD CT
Mailing Address - Street 2:
Mailing Address - City:STONEHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02180-1948
Mailing Address - Country:US
Mailing Address - Phone:623-734-2360
Mailing Address - Fax:
Practice Address - Street 1:16 EMERALD CT
Practice Address - Street 2:
Practice Address - City:STONEHAM
Practice Address - State:MA
Practice Address - Zip Code:02180-1948
Practice Address - Country:US
Practice Address - Phone:623-734-2360
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-23
Last Update Date:2023-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN2349571163WM0705X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WM0705XNursing Service ProvidersRegistered NurseMedical-Surgical