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General NPI Number Information
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NPI Number | 1104365832
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Entity Type | Individual
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Provider Name | JENNIFER DOLIS NP-C
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Gender | Female
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Dates
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Enumeration Date | 02/14/2017
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Last Update Date | 02/14/2017
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Provider Practice Location Address
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Address Line | 400 FRANKLIN TPKE
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City | MAHWAH
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State | NJ
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Zip | 07430-3516
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Country | US
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Telephone | 201-995-1005
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Fax |
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Provider Business Mailing Address
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Address Line | 43 EAGLE CREST WAY
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City | CHESTER
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State | NY
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Zip | 10918-1761
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number | 26NJ00701800
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License Number State | NJ
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