Provider Demographics
NPI:1841734738
Name:DOLAN, MARY ELLEN (MSN,RN, APRN, GNP-BC)
Entity Type:Individual
Prefix:
First Name:MARY ELLEN
Middle Name:
Last Name:DOLAN
Suffix:
Gender:F
Credentials:MSN,RN, APRN, GNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13 DEER RUN
Mailing Address - Street 2:
Mailing Address - City:SPARTA
Mailing Address - State:NJ
Mailing Address - Zip Code:07871-2910
Mailing Address - Country:US
Mailing Address - Phone:973-903-6765
Mailing Address - Fax:
Practice Address - Street 1:13 DEER RUN
Practice Address - Street 2:
Practice Address - City:SPARTA
Practice Address - State:NJ
Practice Address - Zip Code:07871-2910
Practice Address - Country:US
Practice Address - Phone:973-903-6765
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-12-12
Last Update Date:2016-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NN08271800363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology