Individual
DOLIS LEBREAULT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
APN
Contact information
Practice address
275 CHESTNUT ST, NEWARK, NJ 07105-1570
(973) 589-5545
Mailing address
275 CHESTNUT ST, NEWARK, NJ 07105-1570
(973) 589-5545
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
26NR11166500
NJ
363LA2200X
Adult Health Nurse Practitioner
Primary
26NJ00373500
NJ
Other
Enumeration date
09/12/2011
Last updated
01/11/2017
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