Healthcare Provider Details

I. General information

NPI: 1588897219
Provider Name (Legal Business Name): MICHELE ROSE DOLAN L.AC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/28/2009
Last Update Date: 08/28/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

336 FAIRVIEW AVE
HUDSON NY
12534-1203
US

IV. Provider business mailing address

97 CLERMONT ST
ALBANY NY
12203-2408
US

V. Phone/Fax

Practice location:
  • Phone: 518-588-6942
  • Fax:
Mailing address:
  • Phone: 518-588-6942
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number004146-1
License Number StateNY

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: