Provider Demographics
NPI:1326246869
Name:DONNELLY, DOLORES ANN (CRNA)
Entity Type:Individual
Prefix:MRS
First Name:DOLORES
Middle Name:ANN
Last Name:DONNELLY
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4608 OAKVIEW CT
Mailing Address - Street 2:
Mailing Address - City:ELLICOTT CITY
Mailing Address - State:MD
Mailing Address - Zip Code:21042-5938
Mailing Address - Country:US
Mailing Address - Phone:443-538-6115
Mailing Address - Fax:301-754-2503
Practice Address - Street 1:4608 OAKVIEW CT
Practice Address - Street 2:
Practice Address - City:ELLICOTT CITY
Practice Address - State:MD
Practice Address - Zip Code:21042-5938
Practice Address - Country:US
Practice Address - Phone:443-538-6115
Practice Address - Fax:301-754-2503
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR051280367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered