Provider Demographics
NPI:1639302862
Name:DOLEHANTY, CAROLE ANNETTE (FNP-C)
Entity Type:Individual
Prefix:
First Name:CAROLE
Middle Name:ANNETTE
Last Name:DOLEHANTY
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:612 35TH AVE STE 1
Mailing Address - Street 2:
Mailing Address - City:MOLINE
Mailing Address - State:IL
Mailing Address - Zip Code:61265-6176
Mailing Address - Country:US
Mailing Address - Phone:309-788-0014
Mailing Address - Fax:309-623-4638
Practice Address - Street 1:612 35TH AVE STE 1
Practice Address - Street 2:
Practice Address - City:MOLINE
Practice Address - State:IL
Practice Address - Zip Code:61265
Practice Address - Country:US
Practice Address - Phone:309-788-0014
Practice Address - Fax:309-623-4638
Is Sole Proprietor?:No
Enumeration Date:2009-09-04
Last Update Date:2018-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAA-119620363LF0000X
IL209.007547363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily