=====================================================
General NPI Number Information
=====================================================
NPI Number | 1124137773
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | DOLORES A DUVAK CRNP
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/29/2006
-----------------------------------------------------
Last Update Date | 05/08/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 501 S 54TH ST SUITE 196
-----------------------------------------------------
City | PHILADELPHIA
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 19143-1900
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 215-748-9707
-----------------------------------------------------
Fax | 215-748-9708
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1 W ELM ST 2ND FLOOR
-----------------------------------------------------
City | CONSHOHOCKEN
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 19428-2007
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 610-567-6964
-----------------------------------------------------
Fax | 610-567-6170
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 163WC2100X
-----------------------------------------------------
Taxonomy Name | Continence Care Registered Nurse
-----------------------------------------------------
License Number | RN222707L
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 163WC2100X
-----------------------------------------------------
Taxonomy Name | Continence Care Registered Nurse
-----------------------------------------------------
License Number | SP005814
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------