Provider Demographics
NPI:1104852862
Name:DOLAN, RACHEL RHODES (PA-C)
Entity Type:Individual
Prefix:
First Name:RACHEL
Middle Name:RHODES
Last Name:DOLAN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6475 S YALE AVE
Mailing Address - Street 2:#201
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74136-7816
Mailing Address - Country:US
Mailing Address - Phone:918-499-2000
Mailing Address - Fax:918-499-2188
Practice Address - Street 1:6475 S YALE AVE
Practice Address - Street 2:#201
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74136-7816
Practice Address - Country:US
Practice Address - Phone:918-499-2000
Practice Address - Fax:918-499-2188
Is Sole Proprietor?:No
Enumeration Date:2006-06-24
Last Update Date:2008-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK966363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant