Provider Demographics
NPI:1114279965
Name:DORAU, MARISSA (PA-C)
Entity Type:Individual
Prefix:
First Name:MARISSA
Middle Name:
Last Name:DORAU
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 1:2040 HUTTON RD
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:KS
Mailing Address - Zip Code:66109-4526
Mailing Address - Country:US
Mailing Address - Phone:913-299-3700
Mailing Address - Fax:913-721-3316
Practice Address - Street 1:2040 HUTTON RD
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:KS
Practice Address - Zip Code:66109-4526
Practice Address - Country:US
Practice Address - Phone:913-299-3700
Practice Address - Fax:913-721-3316
Is Sole Proprietor?:No
Enumeration Date:2012-10-03
Last Update Date:2024-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORPA160132363AM0700X
KS15-02876363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical