Sharon Lynn Bolar, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

11331 Issued in MN

Practice address

14490 E Fox Lake Rd
Detroit Lakes, MN 56501-7111

Phone

(218) 844-2295

NPI assigned

Jul 17, 2017

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Interoperability endpoints

• Direct secure messaging: everestmenshealth.sharonbolar@145282.advancedmd-direct.com

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1500249600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1500249600000",
    "number": "1003339573",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "14490 E FOX LAKE RD",
            "city": "DETROIT LAKES",
            "state": "MN",
            "postal_code": "565017111",
            "telephone_number": "218-844-2295"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "14490 E FOX LAKE RD",
            "city": "DETROIT LAKES",
            "state": "MN",
            "postal_code": "565017111",
            "telephone_number": "218-844-2295"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BOLAR",
        "first_name": "SHARON",
        "middle_name": "LYNN",
        "name_prefix": "Ms.",
        "credential": "PA-C",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2017-07-17",
        "last_updated": "2017-07-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "MN",
            "license": "11331",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jodi Rae Boerger Wilder, LP
• Anika Bohmer
• Juldie Lynn Bohmer, LPCC
• Melissa Boit
• Randall J. Bolar, M.D.
• Larry W Boomgaarden, B.A., LAC-T
• Lola Marie Booth, LADC
• Kari Jo Borgmann, PT
• Riley Bourdon
• Madison Bowers, PT

• All providers in Detroit Lakes, MN
• Physician Assistant in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 17, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.