Individual
MS. MARY ELIZABETH DOLAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
P.A.
Contact information
Practice address
6763 PAGE AVE, SAINT LOUIS, MO 63133-1635
(314) 678-9857
Mailing address
6763 PAGE AVE, SAINT LOUIS, MO 63133-1635
(314) 678-9857
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
2005040394
MO
363AM0700X
Medical Physician Assistant
2005040394
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2005040394
P.A. LICENSE
MO
Enumeration date
07/13/2006
Last updated
07/21/2022
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