Provider Demographics
NPI:1801074968
Name:DOLAN, AMANDA (RD)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:
Last Name:DOLAN
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:AMANDA
Other - Middle Name:
Other - Last Name:ULATSKY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RD
Mailing Address - Street 1:500 N UNION ST
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:PA
Mailing Address - Zip Code:17057-1950
Mailing Address - Country:US
Mailing Address - Phone:717-944-2225
Mailing Address - Fax:717-944-0932
Practice Address - Street 1:500 N UNION ST
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:PA
Practice Address - Zip Code:17057-1950
Practice Address - Country:US
Practice Address - Phone:717-944-2225
Practice Address - Fax:717-944-0932
Is Sole Proprietor?:No
Enumeration Date:2008-01-31
Last Update Date:2010-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADN003716133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
PADN003716OtherDIETICIAN LICENSE