Provider Demographics
NPI:1588897219
Name:DOLAN, MICHELE ROSE (LAC)
Entity type:Individual
Prefix:
First Name:MICHELE
Middle Name:ROSE
Last Name:DOLAN
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:97 CLERMONT ST
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:NY
Mailing Address - Zip Code:12203-2408
Mailing Address - Country:US
Mailing Address - Phone:518-588-6942
Mailing Address - Fax:
Practice Address - Street 1:336 FAIRVIEW AVE
Practice Address - Street 2:
Practice Address - City:HUDSON
Practice Address - State:NY
Practice Address - Zip Code:12534-1203
Practice Address - Country:US
Practice Address - Phone:518-588-6942
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-08-28
Last Update Date:2009-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY004146-1171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist