MEDICARE: HUNTER DOLAN RN

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	367500000X	Certified Registered Nurse Anesthetist	4704318947	MI
2	163W00000X	Registered Nurse	4704318947	MI

General Provider Information

NPI Number	:	1316519390
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HUNTER DOLAN RN

Provider Business Mailing Address
First Line	:	48790 SALT RIVER DR
Second Line	:
City	:	CHESTERFIELD
State	:	MI
Zip	:	48047-3487
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	48790 SALT RIVER DR
Second Line	:
City	:	CHESTERFIELD
State	:	MI
Zip	:	48047-3487
Country	:	US
Telephone Number	:	586-713-2353
Fax Number	:

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

Provider Enumeration Date	:	07/11/2021
Last Update Date	:	03/26/2026

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