Provider Demographics
NPI:1023258175
Name:BOLING, JODI L (CNS)
Entity type:Individual
Prefix:
First Name:JODI
Middle Name:L
Last Name:BOLING
Suffix:
Gender:F
Credentials:CNS
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:9201 CALUMET AVE
Mailing Address - Street 2:
Mailing Address - City:MUNSTER
Mailing Address - State:IN
Mailing Address - Zip Code:46321-2807
Mailing Address - Country:US
Mailing Address - Phone:219-836-9024
Mailing Address - Fax:219-836-0034
Practice Address - Street 1:9143 INDIANAPOLIS BLVD
Practice Address - Street 2:
Practice Address - City:HIGHLAND
Practice Address - State:IN
Practice Address - Zip Code:46322-2504
Practice Address - Country:US
Practice Address - Phone:219-972-1547
Practice Address - Fax:219-972-1641
Is Sole Proprietor?:No
Enumeration Date:2009-03-03
Last Update Date:2012-09-13
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IN28126677A364S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364S00000XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse Specialist