Basic Information
| Provider Information | |||||||||
| NPI: | 1235457524 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BOLGER | ||||||||
| FirstName: | STEPHANIE | ||||||||
| MiddleName: | LYN | ||||||||
| NamePrefix: | MS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | PA-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 225 GRANDVIEW AVE STE 303 | ||||||||
| Address2: | |||||||||
| City: | CAMP HILL | ||||||||
| State: | PA | ||||||||
| PostalCode: | 170111729 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7179888200 | ||||||||
| FaxNumber: | 7172215644 | ||||||||
| Practice Location | |||||||||
| Address1: | 225 GRANDVIEW AVE STE 303 | ||||||||
| Address2: | |||||||||
| City: | CAMP HILL | ||||||||
| State: | PA | ||||||||
| PostalCode: | 170111729 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7179888200 | ||||||||
| FaxNumber: | 7172215644 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/11/2010 | ||||||||
| LastUpdateDate: | 05/31/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 05/31/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363AS0400X | N | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Surgical | 363AS0400X | MA054012 | PA | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Surgical |
No ID Information.