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MS. SANDRA DOLAK NURSE PRACTITIONER

>> Nurse Practitioner >> Physician Assistants & Advanced Practice Nursing Providers

Registrant NPI Number: 1376672949

Individual Registrant:
MS. SANDRA  DOLAK NURSE PRACTITIONER
Gender: F
Not Sole Proprietor

Location and contact information for practice:
129 KANSAS AVE  WALSENBURG, CO 81089-1818 US
Tel: 719-738-2718  Fax: 719-738-2732

Contact information for business:
23500 US HIGHWAY 160  WALSENBURG, CO 81089-9524 US
Tel: 719-738-5144  Fax: 719-738-5138

Registration Information:
NPI: 1376672949
Entity Type: Individual

Specialty information:

PrimaryCodeCategory/DescriptionStateLicense Number
Y363L00000XPhysician Assistants & Advanced Practice Nursing Providers
Nurse Practitioner
CO51644

Legacy codes, insurance codes and state license numbers:

IssuerNumberStateType




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