Provider Demographics
NPI:1972857241
Name:DOLL-MOISE, WILNIE
Entity Type:Individual
Prefix:
First Name:WILNIE
Middle Name:
Last Name:DOLL-MOISE
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 1:2310 CLARENDON RD
Mailing Address - Street 2:4A
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11226-6144
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2310 CLARENDON RD
Practice Address - Street 2:4A
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11226-6144
Practice Address - Country:US
Practice Address - Phone:347-586-1675
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-11-07
Last Update Date:2012-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY311710164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse