Healthcare Provider Details

I. General information

NPI: 1518364041
Provider Name (Legal Business Name): AMANDA KATHRYN DOLEGA NP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: AMANDA KATHRYN DETORE

II. Dates (important events)

Enumeration Date: 11/26/2014
Last Update Date: 08/14/2026
Certification Date: 08/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 CVS DR
WOONSOCKET RI
02895-6195
US

IV. Provider business mailing address

11706 CLIFTON BLVD
LAKEWOOD OH
44107-2018
US

V. Phone/Fax

Practice location:
  • Phone: 401-765-1500
  • Fax:
Mailing address:
  • Phone: 866-389-2727
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number1231687
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberA190460
License Number StateIA
# 3
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberCOA.16603-NP
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: