MEDICARE: CAROLYN JANE DODSON NP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	390200000X	Student in an Organized Health Care Education/Training Program
2	363L00000X	Nurse Practitioner	4704273522	MI

General Provider Information

NPI Number	:	1013373471
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CAROLYN JANE DODSON NP

Provider Business Mailing Address
First Line	:	50072 LUDWIG CT
Second Line	:
City	:	SHELBY TOWNSHIP
State	:	MI
Zip	:	48317-6346
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	28303 DEQUINDRE RD STE 100
Second Line	:
City	:	MADISON HEIGHTS
State	:	MI
Zip	:	48071-3040
Country	:	US
Telephone Number	:	248-658-1116
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/14/2016
Last Update Date	:	11/06/2025

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