Healthcare Provider Details

I. General information

NPI: 1063669455
Provider Name (Legal Business Name): KIM ANN DOLAN APN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/27/2008
Last Update Date: 08/27/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

351 RIFLE CAMP RD
WEST PATERSON NJ
07424-2726
US

IV. Provider business mailing address

351 RIFLE CAMP RD
WEST PATERSON NJ
07424-2726
US

V. Phone/Fax

Practice location:
  • Phone: 973-345-0644
  • Fax:
Mailing address:
  • Phone: 973-345-0644
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberF401171-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: