Provider Demographics
NPI:1245749506
Name:DOLAN, DIANE A (RN)
Entity Type:Individual
Prefix:
First Name:DIANE
Middle Name:A
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 1:13089 OCEAN HWY
Mailing Address - Street 2:
Mailing Address - City:PAWLEYS ISLAND
Mailing Address - State:SC
Mailing Address - Zip Code:29585-7140
Mailing Address - Country:US
Mailing Address - Phone:843-235-9674
Mailing Address - Fax:
Practice Address - Street 1:13089 OCEAN HWY
Practice Address - Street 2:
Practice Address - City:PAWLEYS ISLAND
Practice Address - State:SC
Practice Address - Zip Code:29585-7140
Practice Address - Country:US
Practice Address - Phone:843-235-9674
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-09-29
Last Update Date:2017-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC229740163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse