Provider Demographics
NPI:1073196994
Name:DOLAN, KATHLEEN ANN (RN)
Entity Type:Individual
Prefix:MISS
First Name:KATHLEEN
Middle Name:ANN
Last Name:DOLAN
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:134 GREAT EAST NECK RD
Mailing Address - Street 2:
Mailing Address - City:WEST BABYLON
Mailing Address - State:NY
Mailing Address - Zip Code:11704-8027
Mailing Address - Country:US
Mailing Address - Phone:631-422-4800
Mailing Address - Fax:
Practice Address - Street 1:134 GREAT EAST NECK RD
Practice Address - Street 2:
Practice Address - City:WEST BABYLON
Practice Address - State:NY
Practice Address - Zip Code:11704-8027
Practice Address - Country:US
Practice Address - Phone:631-422-4800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-29
Last Update Date:2021-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY423984163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse