Provider Demographics
NPI:1124181540
Name:DOOLEY, JOHANNA ANNE (FNP)
Entity Type:Individual
Prefix:MRS
First Name:JOHANNA
Middle Name:ANNE
Last Name:DOOLEY
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18 GRAFFIN DR
Mailing Address - Street 2:
Mailing Address - City:LATHAM
Mailing Address - State:NY
Mailing Address - Zip Code:12110-5609
Mailing Address - Country:US
Mailing Address - Phone:518-580-5550
Mailing Address - Fax:518-580-5556
Practice Address - Street 1:121 EVERETT ROAD
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:NY
Practice Address - Zip Code:12205
Practice Address - Country:US
Practice Address - Phone:518-453-9088
Practice Address - Fax:518-689-6111
Is Sole Proprietor?:No
Enumeration Date:2006-12-18
Last Update Date:2008-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF331313-1363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYRB4522Medicare PIN