Healthcare Provider Details

I. General information

NPI: 1235450552
Provider Name (Legal Business Name): ERICA MARIE DOLAN L.AC., M.AC.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/21/2010
Last Update Date: 06/21/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18480 KENYON AVE
LAKEVILLE MN
55044-6911
US

IV. Provider business mailing address

14085 ALABAMA AVE S
SAVAGE MN
55378-1904
US

V. Phone/Fax

Practice location:
  • Phone: 952-373-0055
  • Fax:
Mailing address:
  • Phone: 612-877-0907
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number1418
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: