Phylia Irene Bolls

Primary specialty

Emergency Registered NurseTaxonomy code 163WE0003X

License

041464045 Issued in IL

Practice address

16918 Oak Park Ave
Tinley Park, IL 60477-2768

Phone

(708) 600-2005

NPI assigned

Jun 14, 2022

Last updated

Jun 14, 2022By the provider in NPPES

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)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Wicked Wellness Spa PLLC

  • Family Medicine Physician
  • Tinley Park, IL
  • NPI 1104610286

  Single Specialty

  NPD Authorized official

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

{
    "created_epoch": "1655164800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1655164800000",
    "number": "1750011748",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3610 W 155TH ST",
            "city": "MARKHAM",
            "state": "IL",
            "postal_code": "604283811",
            "telephone_number": "708-600-2005"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "16918 OAK PARK AVE",
            "city": "TINLEY PARK",
            "state": "IL",
            "postal_code": "604772768",
            "telephone_number": "708-600-2005"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BOLLS",
        "first_name": "PHYLIA",
        "middle_name": "IRENE",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2022-06-14",
        "last_updated": "2022-06-14",
        "certification_date": "2022-06-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163WE0003X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, Emergency",
            "state": "IL",
            "license": "041464045",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Bob Rady, Inc
• Adeola Bamidele Bobade
• Susan Bobko, O.D.
• Body and Soul Health Care P C (Sheila Dawn Robinson, D C)
• Donna Boettge, APNP
• Richard H Bongard, M.D.
• Patricia Bonner
• Sangeeta Subhash Bookseller, PSY.D.
• Tracy M Bouck, LCPC
• Darla Boyd

• Emergency Registered Nurse in Tinley Park, IL
• Providers in Tinley Park, IL by specialty
• Emergency Registered Nurse in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 14, 2022; 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.