Provider Demographics
NPI:1144741513
Name:DOLAN, KEREN ELIZABETH (DCN, MS, CNS, LDN)
Entity Type:Individual
Prefix:DR
First Name:KEREN
Middle Name:ELIZABETH
Last Name:DOLAN
Suffix:
Gender:F
Credentials:DCN, MS, CNS, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:453 CARLISLE DR STE A
Mailing Address - Street 2:
Mailing Address - City:HERNDON
Mailing Address - State:VA
Mailing Address - Zip Code:20170-5611
Mailing Address - Country:US
Mailing Address - Phone:703-468-1241
Mailing Address - Fax:
Practice Address - Street 1:453A CARLISLE DR # 104
Practice Address - Street 2:
Practice Address - City:HERNDON
Practice Address - State:VA
Practice Address - Zip Code:20170-4819
Practice Address - Country:US
Practice Address - Phone:703-468-1241
Practice Address - Fax:703-935-0237
Is Sole Proprietor?:Yes
Enumeration Date:2017-07-06
Last Update Date:2018-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CNS17324133N00000X
MDDX4254133N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist