Provider Demographics
NPI:1972515146
Name:DOLF, SUSAN KATHLEEN (RN,)
Entity Type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:KATHLEEN
Last Name:DOLF
Suffix:
Gender:F
Credentials:RN,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2075 FAIRLANE DR
Mailing Address - Street 2:
Mailing Address - City:MEDFORD
Mailing Address - State:OR
Mailing Address - Zip Code:97501-4126
Mailing Address - Country:US
Mailing Address - Phone:541-601-4350
Mailing Address - Fax:541-245-4159
Practice Address - Street 1:2075 FAIRLANE DR
Practice Address - Street 2:
Practice Address - City:MEDFORD
Practice Address - State:OR
Practice Address - Zip Code:97501-4126
Practice Address - Country:US
Practice Address - Phone:541-601-4350
Practice Address - Fax:541-245-4159
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR163WC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC1500XNursing Service ProvidersRegistered NurseCommunity Health