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General NPI Number Information
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NPI Number | 1760735716
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Entity Type | Individual
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Provider Name | DOUGLAS H LOLLEY CRNP
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Gender | Male
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Dates
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Enumeration Date | 10/15/2012
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Last Update Date | 02/25/2015
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Provider Practice Location Address
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Address Line | 208 PIERSON AVE
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City | CENTREVILLE
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State | AL
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Zip | 35042-2918
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Country | US
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Telephone | 205-926-3283
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Fax | 205-926-4275
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Provider Business Mailing Address
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Address Line | 208 PIERSON AVE
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City | CENTREVILLE
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State | AL
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Zip | 35042-2918
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Country | US
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Telephone | 205-926-3283
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Fax | 205-926-4275
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 1-117341
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License Number State | AL
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