Basic Information
| Provider Information | |||||||||
| NPI: | 1700535614 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | DOLAN | ||||||||
| FirstName: | JACQUELYN | ||||||||
| MiddleName: | MARIE | ||||||||
| NamePrefix: | MISS | ||||||||
| NameSuffix: | |||||||||
| Credential: | RN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 21R DARLENE DR | ||||||||
| Address2: | |||||||||
| City: | BRIDGEWATER | ||||||||
| State: | MA | ||||||||
| PostalCode: | 023241908 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5084045240 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 55 FRUIT ST | ||||||||
| Address2: | |||||||||
| City: | BOSTON | ||||||||
| State: | MA | ||||||||
| PostalCode: | 021142621 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6177262000 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/20/2022 | ||||||||
| LastUpdateDate: | 03/20/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 03/20/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163WE0003X | RN2299349 | MA | Y | Nursing Service Providers | Registered Nurse | Emergency |
No ID Information.