Marcia Lynne Boll, CNP

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

R-124514-9 Issued in MN

Practice address

8399 72ND St SW
Howard Lake, MN 55349-5412

Phone

(612) 314-0418

NPI assigned

Oct 26, 2016

Last updated

Jan 6, 2024By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other names 1

• Marcia Lynne Dally Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Certified Nurse Practitioner

State licenses

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

{
    "created_epoch": "1477440000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1704499200000",
    "number": "1861944753",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8399 72ND ST SW",
            "city": "HOWARD LAKE",
            "state": "MN",
            "postal_code": "553495412",
            "telephone_number": "612-314-0418"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8399 72ND ST SW",
            "city": "HOWARD LAKE",
            "state": "MN",
            "postal_code": "553495412",
            "telephone_number": "612-314-0418"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BOLL",
        "first_name": "MARCIA",
        "middle_name": "LYNNE",
        "credential": "CNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2016-10-26",
        "last_updated": "2024-01-06",
        "certification_date": "2024-01-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "MN",
            "license": "4816",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "MN",
            "license": "R-124514-9",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "MARCIA",
            "last_name": "DALLY",
            "middle_name": "LYNNE",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Louise M Arlien, CNP
• Kelly Bonde
• Craig Butturff, MSPT
• Jennifer Leigh Butturff, D.C.
• James E. Carrabre, MD
• City of Howard Lake (Howard Lake Ambulance Service)

• Family Nurse Practitioner in Howard Lake, MN
• Providers in Howard Lake, MN by specialty
• Family Nurse Practitioner in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 6, 2024; 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.