Provider Demographics
NPI:1194967711
Name:DOLAN, DONNA JEAN (MS, RD)
Entity type:Individual
Prefix:MS
First Name:DONNA
Middle Name:JEAN
Last Name:DOLAN
Suffix:
Gender:F
Credentials:MS, RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6059 160TH AVE
Mailing Address - Street 2:
Mailing Address - City:OLIN
Mailing Address - State:IA
Mailing Address - Zip Code:52320-7672
Mailing Address - Country:US
Mailing Address - Phone:319-484-2418
Mailing Address - Fax:
Practice Address - Street 1:6059 160TH AVE
Practice Address - Street 2:
Practice Address - City:OLIN
Practice Address - State:IA
Practice Address - Zip Code:52320-7672
Practice Address - Country:US
Practice Address - Phone:319-484-2418
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-27
Last Update Date:2009-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA01233133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered