Provider Demographics
NPI:1144928375
Name:DOLKAR CHONZOM, FNU (REGISTERED NURSE)
Entity type:Individual
Prefix:
First Name:FNU
Middle Name:
Last Name:DOLKAR CHONZOM
Suffix:
Gender:F
Credentials:REGISTERED NURSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3022 83RD ST
Mailing Address - Street 2:
Mailing Address - City:EAST ELMHURST
Mailing Address - State:NY
Mailing Address - Zip Code:11370-1919
Mailing Address - Country:US
Mailing Address - Phone:917-605-4824
Mailing Address - Fax:
Practice Address - Street 1:3022 83RD ST
Practice Address - Street 2:
Practice Address - City:EAST ELMHURST
Practice Address - State:NY
Practice Address - Zip Code:11370-1919
Practice Address - Country:US
Practice Address - Phone:917-605-4824
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-02-17
Last Update Date:2023-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY854737-01163WM0705X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WM0705XNursing Service ProvidersRegistered NurseMedical-Surgical