Provider Demographics
NPI:1013373471
Name:DODSON, CAROLYN JANE (NP)
Entity Type:Individual
Prefix:
First Name:CAROLYN
Middle Name:JANE
Last Name:DODSON
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:CAROLYN
Other - Middle Name:JANE
Other - Last Name:IRELAND
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:NP
Mailing Address - Street 1:5685 VICTORY CIRCEL
Mailing Address - Street 2:
Mailing Address - City:STERLING HEIGHTS
Mailing Address - State:MI
Mailing Address - Zip Code:48310
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:18610 FENKELL ST
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48223-2378
Practice Address - Country:US
Practice Address - Phone:313-723-6000
Practice Address - Fax:313-424-4058
Is Sole Proprietor?:No
Enumeration Date:2016-01-14
Last Update Date:2023-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
MI4704273522363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program