Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 224P00000X | Prosthetist | ||
N | 225000000X | Orthotic Fitter | NC |
NPI | 1710015466 |
---|---|
Provider Name | Mr. Shaun O Dolen |
First Address | Skyland, NC 28776-0428 |
Second Address | Fletcher, NC 28732-8241 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/03/2007 |
Last Update Date | 20/11/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
7795114 | (05) | NC |