Provider Demographics
NPI:1326326703
Name:DOLOS, JENELL ANTOINETTE
Entity Type:Individual
Prefix:MRS
First Name:JENELL
Middle Name:ANTOINETTE
Last Name:DOLOS
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 1:1254 VERANO DR
Mailing Address - Street 2:
Mailing Address - City:BULLHEAD CITY
Mailing Address - State:AZ
Mailing Address - Zip Code:86442-6926
Mailing Address - Country:US
Mailing Address - Phone:928-234-2273
Mailing Address - Fax:
Practice Address - Street 1:2150 SILVER CREEK RD
Practice Address - Street 2:
Practice Address - City:BULLHEAD CITY
Practice Address - State:AZ
Practice Address - Zip Code:86442-8472
Practice Address - Country:US
Practice Address - Phone:928-763-8700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-08-02
Last Update Date:2011-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other