Provider Demographics
NPI:1386710028
Name:DOLAN, LISA GAYE (RN)
Entity type:Individual
Prefix:MRS
First Name:LISA
Middle Name:GAYE
Last Name:DOLAN
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 1:5 BABE LANE
Mailing Address - Street 2:HOLLY HILLS
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:25130
Mailing Address - Country:US
Mailing Address - Phone:304-369-6525
Mailing Address - Fax:
Practice Address - Street 1:69 AVENUE B
Practice Address - Street 2:BOONE COUNTY OF EDUCATIONS
Practice Address - City:MADISON
Practice Address - State:WV
Practice Address - Zip Code:25130
Practice Address - Country:US
Practice Address - Phone:304-369-3131
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV39176163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV3810003838Medicaid