Provider Demographics
NPI:1215240999
Name:DOLOSON, INETA (LPN)
Entity type:Individual
Prefix:
First Name:INETA
Middle Name:
Last Name:DOLOSON
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4610 CARPENTER AVE FL 2
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10470-1422
Mailing Address - Country:US
Mailing Address - Phone:347-256-6103
Mailing Address - Fax:
Practice Address - Street 1:4610 CARPENTER AVE FL 2
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10470-1422
Practice Address - Country:US
Practice Address - Phone:347-256-6103
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-22
Last Update Date:2010-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY226377164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse