Provider Demographics
NPI:1235313347
Name:DOLCH, KERRY JOHN (LPN)
Entity type:Individual
Prefix:MR
First Name:KERRY
Middle Name:JOHN
Last Name:DOLCH
Suffix:
Gender:M
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3543 PIN OAK CT
Mailing Address - Street 2:
Mailing Address - City:GROVE CITY
Mailing Address - State:OH
Mailing Address - Zip Code:43123-9127
Mailing Address - Country:US
Mailing Address - Phone:614-801-1081
Mailing Address - Fax:
Practice Address - Street 1:3543 PIN OAK CT
Practice Address - Street 2:
Practice Address - City:GROVE CITY
Practice Address - State:OH
Practice Address - Zip Code:43123-9127
Practice Address - Country:US
Practice Address - Phone:614-801-1081
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-26
Last Update Date:2007-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH128619164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse