Provider Demographics
NPI:1558695148
Name:DOTSON, CAROL ANN (LPN)
Entity Type:Individual
Prefix:MS
First Name:CAROL
Middle Name:ANN
Last Name:DOTSON
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:MISS
Other - First Name:CAROL
Other - Middle Name:ANN
Other - Last Name:HERRING
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPN
Mailing Address - Street 1:4344 N 69TH ST
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53216-1127
Mailing Address - Country:US
Mailing Address - Phone:414-610-4886
Mailing Address - Fax:
Practice Address - Street 1:4344 N 69TH ST
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53216-1127
Practice Address - Country:US
Practice Address - Phone:414-852-3434
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-09-29
Last Update Date:2012-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI29555-031164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse