Provider Demographics
NPI:1326157223
Name:DOLAN, KATHRYN R (FNP)
Entity Type:Individual
Prefix:
First Name:KATHRYN
Middle Name:R
Last Name:DOLAN
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 1:153 W GENESEE ST
Mailing Address - Street 2:
Mailing Address - City:CHITTENANGO
Mailing Address - State:NY
Mailing Address - Zip Code:13037-1528
Mailing Address - Country:US
Mailing Address - Phone:315-687-5100
Mailing Address - Fax:315-687-0252
Practice Address - Street 1:153 W GENESEE ST
Practice Address - Street 2:
Practice Address - City:CHITTENANGO
Practice Address - State:NY
Practice Address - Zip Code:13037-1528
Practice Address - Country:US
Practice Address - Phone:315-687-5100
Practice Address - Fax:315-687-0252
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2021-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF332436363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02326709Medicaid
NY02326709Medicaid
NY911103OtherMVP HEALTH CARE
NY02326709Medicaid
NYCC5553Medicare PIN