Healthcare Provider Details

I. General information

NPI: 1013820117
Provider Name (Legal Business Name): CRYSTAL LYNN DOLAN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/28/2026
Last Update Date: 09/28/2026
Certification Date: 09/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14201 NE 20TH AVE
VANCOUVER WA
98686-6410
US

IV. Provider business mailing address

15019 NE 20TH AVE
VANCOUVER WA
98686-1458
US

V. Phone/Fax

Practice location:
  • Phone: 360-882-2778
  • Fax:
Mailing address:
  • Phone: 503-913-5597
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN70045073
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: