Provider Demographics
NPI:1356420863
Name:KATHLEEN A DOLEZAL APRN PC
Entity type:Organization
Organization Name:KATHLEEN A DOLEZAL APRN PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER, BILLING COMPANY
Authorized Official - Prefix:
Authorized Official - First Name:NAOMI
Authorized Official - Middle Name:
Authorized Official - Last Name:POCKLINGTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:866-602-6822
Mailing Address - Street 1:616 HELENA AVE STE 301
Mailing Address - Street 2:
Mailing Address - City:HELENA
Mailing Address - State:MT
Mailing Address - Zip Code:59601-3654
Mailing Address - Country:US
Mailing Address - Phone:406-442-3323
Mailing Address - Fax:
Practice Address - Street 1:616 HELENA AVE
Practice Address - Street 2:
Practice Address - City:HELENA
Practice Address - State:MT
Practice Address - Zip Code:59601-3654
Practice Address - Country:US
Practice Address - Phone:406-495-7220
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-03
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
163WP0808X
MT17403261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
No163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
000083804Medicare ID - Type Unspecified