Provider Demographics
NPI:1770179863
Name:DOLIN, VICKI
Entity Type:Individual
Prefix:
First Name:VICKI
Middle Name:
Last Name:DOLIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 247
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:WV
Mailing Address - Zip Code:25130-0247
Mailing Address - Country:US
Mailing Address - Phone:304-369-0451
Mailing Address - Fax:
Practice Address - Street 1:347 KENMORE DR STE 1A
Practice Address - Street 2:
Practice Address - City:DANVILLE
Practice Address - State:WV
Practice Address - Zip Code:25053-7083
Practice Address - Country:US
Practice Address - Phone:304-369-0451
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-14
Last Update Date:2020-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant