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MS. SANDRA DOLAK NURSE PRACTITIONER
>> Nurse Practitioner >> Physician Assistants & Advanced Practice Nursing ProvidersRegistrant NPI Number: 1376672949
Individual Registrant:MS. SANDRA DOLAK NURSE PRACTITIONER
Gender: F
Not Sole Proprietor
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
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
Tel: 719-738-5144 Fax: 719-738-5138
Registration Information:
NPI: 1376672949
Entity Type: Individual
Entity Type: Individual
Specialty information:
| Primary | Code | Category/Description | State | License Number |
|---|---|---|---|---|
| Y | 363L00000X | Physician Assistants & Advanced Practice Nursing Providers Nurse Practitioner | CO | 51644 |
Legacy codes, insurance codes and state license numbers:
| Issuer | Number | State | Type |
|---|---|---|---|
