Basic Information
| Provider Information | |||||||||
| NPI: | 1770518482 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | DOOLEY | ||||||||
| FirstName: | DAWN | ||||||||
| MiddleName: | M | ||||||||
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| Credential: | FNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1351 ROUTE 55 | ||||||||
| Address2: | SUITE 200 | ||||||||
| City: | LAGRANGEVILLE | ||||||||
| State: | NY | ||||||||
| PostalCode: | 125405108 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8454759660 | ||||||||
| FaxNumber: | 8454759938 | ||||||||
| Practice Location | |||||||||
| Address1: | 2044 ROUTE 32 | ||||||||
| Address2: | SUITE 4 | ||||||||
| City: | MODENA | ||||||||
| State: | NY | ||||||||
| PostalCode: | 12548 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8458835176 | ||||||||
| FaxNumber: | 8458835177 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/11/2006 | ||||||||
| LastUpdateDate: | 02/02/2017 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163W00000X | 407982-1 | NY | N | Nursing Service Providers | Registered Nurse | 363LF0000X | 331575 | NY | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family | 363L00000X | 331575 | NY | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner |
ID Information
| ID | Type | State | Issuer | Description | 03652242 | 05 | NY | MEDICAID |