Provider Demographics
NPI:1598489627
Name:DOLAN, JEANETTE AUXTINEE (RNC, IBCLC)
Entity Type:Individual
Prefix:
First Name:JEANETTE
Middle Name:AUXTINEE
Last Name:DOLAN
Suffix:
Gender:F
Credentials:RNC, IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2265 SUNCREST BREEZE
Mailing Address - Street 2:
Mailing Address - City:BERRIEN SPRINGS
Mailing Address - State:MI
Mailing Address - Zip Code:49103-8715
Mailing Address - Country:US
Mailing Address - Phone:269-313-1371
Mailing Address - Fax:
Practice Address - Street 1:2265 SUNCREST BREEZE
Practice Address - Street 2:
Practice Address - City:BERRIEN SPRINGS
Practice Address - State:MI
Practice Address - Zip Code:49103-8715
Practice Address - Country:US
Practice Address - Phone:269-313-1371
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-03
Last Update Date:2022-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VAL-15206163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant