Provider Demographics
NPI:1194067744
Name:DOLBACK, BETTY A (RN)
Entity type:Individual
Prefix:MS
First Name:BETTY
Middle Name:A
Last Name:DOLBACK
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P.O. BOX 455
Mailing Address - Street 2:1585 MILITARY TURNPIKE CVES - YANDON DILLON
Mailing Address - City:PLATTSBURGH
Mailing Address - State:NY
Mailing Address - Zip Code:12901
Mailing Address - Country:US
Mailing Address - Phone:518-942-6691
Mailing Address - Fax:518-561-5624
Practice Address - Street 1:1585 MILITARY TURNPIKE
Practice Address - Street 2:CVES - YANDON DILLON
Practice Address - City:PLATTSBURGH
Practice Address - State:NY
Practice Address - Zip Code:12901
Practice Address - Country:US
Practice Address - Phone:518-942-6691
Practice Address - Fax:518-561-5624
Is Sole Proprietor?:No
Enumeration Date:2013-03-21
Last Update Date:2013-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY22-368972163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool