Provider Demographics
NPI:1720203789
Name:DOOLEY, NICKOLE A (DO)
Entity Type:Individual
Prefix:
First Name:NICKOLE
Middle Name:A
Last Name:DOOLEY
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2650 RIDGE AVE
Mailing Address - Street 2:EVANSTON HOSPITAL
Mailing Address - City:EVANSTON
Mailing Address - State:IL
Mailing Address - Zip Code:60201-1718
Mailing Address - Country:US
Mailing Address - Phone:847-570-1206
Mailing Address - Fax:847-570-1248
Practice Address - Street 1:103 S GREENLEAF ST
Practice Address - Street 2:SUITE J
Practice Address - City:GURNEE
Practice Address - State:IL
Practice Address - Zip Code:60031-3380
Practice Address - Country:US
Practice Address - Phone:847-599-8899
Practice Address - Fax:847-599-8897
Is Sole Proprietor?:No
Enumeration Date:2007-04-16
Last Update Date:2021-02-10
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IL036-116737207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036-116737OtherIL STATE LIC