Healthcare Provider Details

I. General information

NPI: 1710722756
Provider Name (Legal Business Name): JACQUELINE OLIVIA DOLSEN DNP, RN, NNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/01/2024
Last Update Date: 11/17/2024
Certification Date: 11/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 W CALIFORNIA BLVD
PASADENA CA
91105-3010
US

IV. Provider business mailing address

12444 VENICE BLVD APT 315
LOS ANGELES CA
90066-5535
US

V. Phone/Fax

Practice location:
  • Phone: 800-903-9233
  • Fax:
Mailing address:
  • Phone: 248-515-4668
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LN0000X
TaxonomyNeonatal Nurse Practitioner
License Number95031392
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: