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NPI Code Detail

MEDICARE: KATHRYN LORRAINE DOLEZAL FNP

MEDICARE: KATHRYN LORRAINE DOLEZAL FNP
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
1363LF0000XFamily Nurse Practitioner16293CA

General Provider Information

NPI Number : 1982645180
Entity Type Code : Individual
Provider Name (Legal Business Name) : KATHRYN LORRAINE DOLEZAL FNP
Provider Business Mailing Address
First Line : 58 LOS PALOS DR
Second Line :
City : SAN LUIS OBISPO
State : CA
Zip : 93401-7727
Country : US
Telephone Number : 805-801-7400
Fax Number :
Provider Business Practice Location Address
First Line : 2180 JOHNSON AVE
Second Line :
City : SAN LUIS OBISPO
State : CA
Zip : 93401-4558
Country : US
Telephone Number : 805-788-8294
Fax Number : 805-203-5383
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/09/2006
Last Update Date : 01/27/2026

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