Provider Demographics
NPI:1235967001
Name:DOLL, DANAE LYNELLE
Entity type:Individual
Prefix:
First Name:DANAE
Middle Name:LYNELLE
Last Name:DOLL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3520 HUGHES AVE APT 318
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90034-7558
Mailing Address - Country:US
Mailing Address - Phone:937-607-0387
Mailing Address - Fax:937-607-0387
Practice Address - Street 1:100 S LOS ROBLES AVE # 501
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91101-2453
Practice Address - Country:US
Practice Address - Phone:626-564-3016
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-23
Last Update Date:2024-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95275974163WC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC0200XNursing Service ProvidersRegistered NurseCritical Care Medicine