Healthcare Provider Details

I. General information

NPI: 1376174607
Provider Name (Legal Business Name): ELIZABETH DOLLINGER PMHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/27/2020
Last Update Date: 01/27/2020
Certification Date: 01/27/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

103 WHITE SPRUCE BLVD
ROCHESTER NY
14623-1610
US

IV. Provider business mailing address

103 WHITE SPRUCE BLVD
ROCHESTER NY
14623-1610
US

V. Phone/Fax

Practice location:
  • Phone: 852-292-5830
  • Fax: 585-292-5847
Mailing address:
  • Phone: 585-292-5830
  • Fax: 585-292-5847

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number402895
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: