Provider Demographics
NPI:1407095391
Name:DOOLIN, DOROTHEA JOAN (FNP)
Entity Type:Individual
Prefix:
First Name:DOROTHEA
Middle Name:JOAN
Last Name:DOOLIN
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 1:1121 S INDIANA AVE
Mailing Address - Street 2:
Mailing Address - City:CROWN POINT
Mailing Address - State:IN
Mailing Address - Zip Code:46307-7205
Mailing Address - Country:US
Mailing Address - Phone:219-663-2160
Mailing Address - Fax:219-663-7658
Practice Address - Street 1:1121 S INDIANA AVE
Practice Address - Street 2:
Practice Address - City:CROWN POINT
Practice Address - State:IN
Practice Address - Zip Code:46307-7205
Practice Address - Country:US
Practice Address - Phone:219-663-2160
Practice Address - Fax:219-663-7658
Is Sole Proprietor?:No
Enumeration Date:2009-02-17
Last Update Date:2012-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71002737A363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner