Healthcare Provider Details

I. General information

NPI: 1518071257
Provider Name (Legal Business Name): SHIRLEY TOWNSEND DOLAN R.N.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/19/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

830 CHALKSTONE AVE
PROVIDENCE RI
02908-4734
US

IV. Provider business mailing address

31 LISA LN
BRISTOL RI
02809-4564
US

V. Phone/Fax

Practice location:
  • Phone: 401-273-7100
  • Fax: 401-525-2549
Mailing address:
  • Phone: 401-273-7100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number21110
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: