Provider Demographics
NPI:1770518482
Name:DOOLEY, DAWN M (FNP)
Entity type:Individual
Prefix:
First Name:DAWN
Middle Name:M
Last Name:DOOLEY
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1351 ROUTE 55
Mailing Address - Street 2:SUITE 200
Mailing Address - City:LAGRANGEVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:12540-5108
Mailing Address - Country:US
Mailing Address - Phone:845-475-9660
Mailing Address - Fax:845-475-9938
Practice Address - Street 1:2044 ROUTE 32
Practice Address - Street 2:SUITE 4
Practice Address - City:MODENA
Practice Address - State:NY
Practice Address - Zip Code:12548
Practice Address - Country:US
Practice Address - Phone:845-883-5176
Practice Address - Fax:845-883-5177
Is Sole Proprietor?:No
Enumeration Date:2006-07-11
Last Update Date:2017-02-02
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY407982-1163W00000X
NY331575363LF0000X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03652242Medicaid
NYQ55403Medicare UPIN
NY1319GX0251Medicare ID - Type Unspecified
NY03652242Medicaid