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Individual

NICKY DOLLA

Active
Sole proprietor
No

Provider details

NPI number
Gender
F

Contact information

Practice address
2 SQUIRE CT, REISTERSTOWN, MD 21136-6414
(301) 437-1780
Mailing address
2 SQUIRE CT, REISTERSTOWN, MD 21136-6414
(301) 437-1780

Taxonomy

Speciality
Code
Description
License number
State
163WP0809X
Adult Psychiatric/Mental Health Registered Nurse
210399
MD
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
210399
MD

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
100070870
NONE
Enumeration date
04/26/2022
Last updated
04/26/2022
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