MEDICARE: KATHLEEN DOLAN APN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	26NJ00479000	NJ

General Provider Information

NPI Number	:	1477974418
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATHLEEN DOLAN APN

Provider Business Mailing Address
First Line	:	113 MASSACHUSETTS AVE
Second Line	:
City	:	CHERRY HILL
State	:	NJ
Zip	:	08002-3131
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	282 CHESTER AVE
Second Line	:
City	:	MOORESTOWN
State	:	NJ
Zip	:	08057-3306
Country	:	US
Telephone Number	:	856-222-3292
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/18/2013
Last Update Date	:	12/18/2013

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