Provider Demographics
NPI:1518364041
Name:DOLEGA, AMANDA KATHRYN (NP-C)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:KATHRYN
Last Name:DOLEGA
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:AMANDA
Other - Middle Name:KATHRYN
Other - Last Name:DETORE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1501 BELLE AVE
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:OH
Mailing Address - Zip Code:44107-4203
Mailing Address - Country:US
Mailing Address - Phone:440-666-9997
Mailing Address - Fax:
Practice Address - Street 1:28100 CHAGRIN BLVD
Practice Address - Street 2:CVS MINUTE CLINIC
Practice Address - City:WOODMERE
Practice Address - State:OH
Practice Address - Zip Code:44122-4522
Practice Address - Country:US
Practice Address - Phone:866-389-2727
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-11-26
Last Update Date:2014-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHCOA.16603-NP363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily