Provider Demographics
NPI:1295598795
Name:DOLEZAL, ANNE (BS, RN, IBCLC)
Entity type:Individual
Prefix:
First Name:ANNE
Middle Name:
Last Name:DOLEZAL
Suffix:
Gender:F
Credentials:BS, RN, IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:58 CLIFTON COUNTRY RD STE 106
Mailing Address - Street 2:
Mailing Address - City:CLIFTON PARK
Mailing Address - State:NY
Mailing Address - Zip Code:12065-3846
Mailing Address - Country:US
Mailing Address - Phone:518-344-6733
Mailing Address - Fax:
Practice Address - Street 1:58 CLIFTON COUNTRY RD STE 106
Practice Address - Street 2:
Practice Address - City:CLIFTON PARK
Practice Address - State:NY
Practice Address - Zip Code:12065-3846
Practice Address - Country:US
Practice Address - Phone:518-344-6733
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-02-06
Last Update Date:2024-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYL-313026174N00000X
NY645567163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant
No174N00000XOther Service ProvidersLactation Consultant, Non-RN