Provider Demographics
NPI:1023472826
Name:DOLOMON, JENNIFER
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:DOLOMON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:
Other - Last Name:DOLOMON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RN
Mailing Address - Street 1:12655 W HOUSTON CENTER BLVD
Mailing Address - Street 2:APT 15304
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77082-2756
Mailing Address - Country:US
Mailing Address - Phone:901-216-6089
Mailing Address - Fax:
Practice Address - Street 1:12655 W HOUSTON CENTER BLVD
Practice Address - Street 2:APT 15304
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77082-2756
Practice Address - Country:US
Practice Address - Phone:901-216-6089
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-04-07
Last Update Date:2016-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNRN0000181398163WC0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC0400XNursing Service ProvidersRegistered NurseCase Management