MEDICARE: KIM ANN DOLAN APN

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	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	F401171-1	NY

General Provider Information

NPI Number	:	1063669455
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KIM ANN DOLAN APN

Provider Business Mailing Address
First Line	:	351 RIFLE CAMP RD
Second Line	:
City	:	WEST PATERSON
State	:	NJ
Zip	:	07424-2726
Country	:	US
Telephone Number	:	973-345-0644
Fax Number	:

Provider Business Practice Location Address
First Line	:	351 RIFLE CAMP RD
Second Line	:
City	:	WEST PATERSON
State	:	NJ
Zip	:	07424-2726
Country	:	US
Telephone Number	:	973-345-0644
Fax Number	:

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

Provider Enumeration Date	:	08/27/2008
Last Update Date	:	08/27/2008

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