PENNY BOLEN (NPI# 1487941886) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1487941886 |
| Entity Type | Individual |
| Full Name | PENNY BOLEN |
| Credential | RD, LDN |
| Practice Address |
1401 E State St Rockford IL 61104-2315 |
| Mailing Address |
6623 Valley Trail Rd Rockford IL 61109-4599 |
| Practice Telephone | 8154894662 |
| Practice Fax Number | 8159612438 |
| Enumeration Date | 2011-07-06 |
| Last Update Date | 2011-07-06 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 133V00000X | Dietitian, Registered | 164.001351 | IL | Dietary & Nutritional Service Providers |
| Street Address |
1401 E STATE ST |
| City | ROCKFORD |
| State | IL |
| Zip Code | 61104-2315 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1003899196 | Thomas Danko | Pediatrics | 1401 E State St, Rockford, IL 61104-2315 | 2005-11-22 |
| 1184232621 | Sound Physicians Emergency Medicine of Illinois LLC | Emergency Medicine | 1401 E State St, Rockford, IL 61104-2315 | 2020-07-21 |
| 1235764556 | Alexandra Paganis | Nurse Practitioner | 1401 E State St, Rockford, IL 61104-2315 | 2020-03-06 |
| 1538790266 | Sherri L Paprocki | Emergency Medicine | 1401 E State St, Rockford, IL 61104-2315 | 2020-01-31 |
| 1417593310 | Jason C Hipe | Registered Nurse | 1401 E State St, Rockford, IL 61104-2315 | 2019-11-26 |
| 1487298642 | Matthew Montgomery | Physical Therapist | 1401 E State St, Rockford, IL 61104-2315 | 2019-10-31 |
| 1265076541 | Sarah Kemp | Occupational Therapist | 1401 E State St, Rockford, IL 61104-2315 | 2019-10-30 |
| 1891341939 | Swedishamerican Hospital | Pharmacy | 1401 E State St, Rockford, IL 61104-2315 | 2019-08-14 |
| 1306408885 | Jonathan Ray Nelson | Physical Therapy Assistant | 1401 E State St, Rockford, IL 61104-2315 | 2019-07-03 |
| 1124680608 | Kirsten Sympson | Occupational Therapy Assistant | 1401 E State St, Rockford, IL 61104-2315 | 2019-07-03 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1699216564 | Swedishamerican Hospital | Nutritionist | 1415 E. State St., Lower Level A3, Rockford, IL 61104 | 2017-03-13 |
| 1376950485 | Swedishamerican Hospital | Nurse Practitioner | 1340 Charles St Ste 200, Rockford, IL 61104 | 2014-07-21 |
| 1871907774 | Oday Alsarraf | Psychiatry & Neurology | 1401 E State Street, Center for Mental Health, Swedish American Hospital, Rockford, IL 61104 | 2014-06-18 |
| 1962652339 | Children's Home and Aid | Community/Behavioral Health | 424 7th St, Rockford, IL 61104 | 2008-09-23 |
| 1689729535 | Swedishamerican Hospital | Nurse Practitioner | 1340 Charles St Ste 100, Rockford, IL 61104 | 2007-01-23 |
| 1790873016 | David J Schleicher | Obstetrics & Gynecology | 209 9th St Ste 200, Rockford, IL 61104 | 2006-10-11 |
| 1013026624 | Thomas Ryan Moss | Dentist | 1415 E State Street, Rockford, IL 61104 | 2006-08-29 |
| 1366452096 | Arturo Santiago Manas | Obstetrics & Gynecology | 1415 E State St Fl 8, Rockford, IL 61104 | 2006-08-08 |
| 1245263268 | William John Stout | Physician Assistant | 1401 E State Street, Rockford, IL 61104 | 2006-07-10 |
| 1689604969 | Prabha Chand Dosi | Pediatrics | 1401 E. State Street, Rockford, IL 61104 | 2006-07-03 |
| Find all providers in zip 61104 | ||||
| Taxonomy Code | 133V00000X |
| Grouping | Dietary & Nutritional Service Providers |
| Classification | Dietitian, Registered |
| A registered dietician (RD) is a food and nutrition expert who has successfully completed a minimum of a bachelor’s degree at a US regionally accredited university or college and course work approved by The American Dietetic Association (ADA); an ADA-accredited or approved, supervised practice program, typically 6 to 12 months in length; a national examination administered by the Commission on Dietetic Registration; and continuing professional educational requirements to maintain registration. |
| Notes: Source: The American Dietetic Association. Becoming a Registered Dietitian – a food and nutrition expert. Chicago, IL: The American Dietetic Association, July 1997. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1902404908 | Christine L Lauer | Dietitian, Registered | 24 Coral Dr Ne, Rockford, MI 49341-8514 | 2020-10-12 |
| 1336758903 | Sara Mattillion | Dietitian, Registered | 930 Winthrop Ln, Rockford, IL 61107-3446 | 2020-07-29 |
| 1316560220 | Jacqueline Marie Kirchner | Dietitian, Registered | 3827 Abbotsford Rd, Rockford, IL 61107-3669 | 2020-05-26 |
| 1548811995 | Allison Vander Heyden | Dietitian, Registered | 122 Sherman St, Rockford, IL 61103-6356 | 2019-09-26 |
| 1730427501 | Patricia Mary Beckemeyer | Dietitian, Registered | 251 Bienterra Trl, Apt 8, Rockford, IL 61107-5870 | 2013-01-29 |
| 1376760405 | Raylene M Foster | Dietitian, Registered | 3585 River Edge View Ct Ne, Rockford, MI 49341-7220 | 2007-04-19 |
| 1275162653 | Andrea Contreras | Dietitian, Registered | 4615 E State St Ste 202, Rockford, IL 61108-2158 | 2020-04-07 |
| 1376170183 | Nicole Ann O'neill | Dietitian, Registered | 5666 E State St, Rockford, IL 61108-2425 | 2020-03-24 |
| 1063914760 | Erika J Oltmanns | Dietitian, Registered | 2300 N Rockton Ave, Rockford, IL 61103-3619 | 2018-03-08 |
| 1730696113 | Alyssa Klehr | Dietitian, Registered | 4615 E State St Ste 202, Rockford, IL 61108-2158 | 2018-01-06 |
| Find all providers in ROCKFORD | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.