Provider Demographics
NPI:1336479211
Name:DOLS, JULIETTE (CNM)
Entity Type:Individual
Prefix:
First Name:JULIETTE
Middle Name:
Last Name:DOLS
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:JULIETTE
Other - Middle Name:
Other - Last Name:AST
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:7339 MADISON ST
Mailing Address - Street 2:
Mailing Address - City:FOREST PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60130-1543
Mailing Address - Country:US
Mailing Address - Phone:708-386-2400
Mailing Address - Fax:708-366-7035
Practice Address - Street 1:7339 MADISON ST
Practice Address - Street 2:
Practice Address - City:FOREST PARK
Practice Address - State:IL
Practice Address - Zip Code:60130-1543
Practice Address - Country:US
Practice Address - Phone:708-386-2400
Practice Address - Fax:708-366-7035
Is Sole Proprietor?:No
Enumeration Date:2009-12-28
Last Update Date:2009-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife