MEDICARE: NANCY DOOLING 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	363LW0102X	Women's Health Nurse Practitioner	13967	CA
2	363LF0000X	Family Nurse Practitioner	13967	CA
3	363LF0000X	Family Nurse Practitioner	AP3717	AZ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	RN3496710	OTHER	CA	MEDI-CAL

General Provider Information

NPI Number	:	1427148246
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NANCY DOOLING NP

Provider Business Mailing Address
First Line	:	813 HANCOCK RD
Second Line	:
City	:	BULLHEAD CITY
State	:	AZ
Zip	:	86442-5032
Country	:	US
Telephone Number	:	928-704-9700
Fax Number	:

Provider Business Practice Location Address
First Line	:	813 HANCOCK RD
Second Line	:
City	:	BULLHEAD CITY
State	:	AZ
Zip	:	86442-5032
Country	:	US
Telephone Number	:	928-704-9700
Fax Number	:

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

Provider Enumeration Date	:	10/13/2006
Last Update Date	:	08/29/2011

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