Provider Demographics
NPI:1275299307
Name:DOLAN, FALICIA
Entity Type:Individual
Prefix:
First Name:FALICIA
Middle Name:
Last Name:DOLAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:804 BROAD ST
Mailing Address - Street 2:
Mailing Address - City:SUMMERSVILLE
Mailing Address - State:WV
Mailing Address - Zip Code:26651-1796
Mailing Address - Country:US
Mailing Address - Phone:304-872-2090
Mailing Address - Fax:304-872-2574
Practice Address - Street 1:804 BROAD ST
Practice Address - Street 2:
Practice Address - City:SUMMERSVILLE
Practice Address - State:WV
Practice Address - Zip Code:26651-1796
Practice Address - Country:US
Practice Address - Phone:304-872-2090
Practice Address - Fax:304-872-2574
Is Sole Proprietor?:No
Enumeration Date:2021-11-12
Last Update Date:2021-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes373H00000XNursing Service Related ProvidersDay Training/Habilitation Specialist