Mary Cay Bolser, ARNP

Primary specialty

Nurse PractitionerTaxonomy code 363L00000X

License

209-000358 Issued in IL

Practice address

311 W Fairchild St
Danville, IL 61832-3876

Phone

(217) 431-7898

Fax

(217) 554-1750

NPI assigned

Jul 30, 2006

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 2

Other names 1

• Mary Cay Declue Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

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 and National Provider Directory roles.

• Physician Services Corporation of Southern Illinois Inc.

  • Internal Medicine Physician
  • Mount Vernon, IL
  • NPI 1831101807
  NPD (past)

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

{
    "created_epoch": "1154217600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1521417600000",
    "number": "1801801568",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "611 W PARK ST",
            "city": "URBANA",
            "state": "IL",
            "postal_code": "618012529",
            "telephone_number": "217-383-3311"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "311 W FAIRCHILD ST",
            "city": "DANVILLE",
            "state": "IL",
            "postal_code": "618323876",
            "telephone_number": "217-431-7898",
            "fax_number": "217-554-1750"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BOLSER",
        "first_name": "MARY",
        "middle_name": "CAY",
        "credential": "ARNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-07-30",
        "last_updated": "2018-03-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "IL",
            "license": "209-000358",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RR GROUP",
            "identifier": "CE9335",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RR MEDICARE NUMBER",
            "identifier": "P00393307",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "MARY",
            "last_name": "DECLUE",
            "middle_name": "CAY",
            "credential": "ARNP",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Emily Blue, LCSW
• Nancy Ann Blue, RPH
• Kumar Bobba, M.D.
• John Joseph Bodensteiner, RPH
• Kelly L Boeger
• Elizabeth Bosch, DNP
• Jeremy Lee Bosch, M.S.W., L.S.W.
• Makayla Bosch
• Kirk M Bott, DPM
• Alicia L Boudreau

• Nurse Practitioner in Danville, IL
• Providers in Danville, IL by specialty
• Nurse Practitioner in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 19, 2018; 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.