Healthcare Provider Details

I. General information

NPI: 1790379659
Provider Name (Legal Business Name): KATHERINE J DOLAN FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/22/2021
Last Update Date: 02/22/2021
Certification Date: 02/22/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

227 W 27TH ST
NEW YORK NY
10001-5902
US

IV. Provider business mailing address

423 E 83RD ST APT C
NEW YORK NY
10028-5516
US

V. Phone/Fax

Practice location:
  • Phone: 212-217-4190
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberF345449-01
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: