Provider Demographics
NPI:1407914252
Name:DOLTON, PAULINE CIA (PA)
Entity Type:Individual
Prefix:
First Name:PAULINE
Middle Name:CIA
Last Name:DOLTON
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:PAULINE
Other - Middle Name:CIA
Other - Last Name:OWENS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:1910 S FALCON AVE
Mailing Address - Street 2:
Mailing Address - City:CLAREMORE
Mailing Address - State:OK
Mailing Address - Zip Code:74019-2237
Mailing Address - Country:US
Mailing Address - Phone:918-341-1000
Mailing Address - Fax:918-403-6309
Practice Address - Street 1:1910 S FALCON AVE
Practice Address - Street 2:
Practice Address - City:CLAREMORE
Practice Address - State:OK
Practice Address - Zip Code:74019
Practice Address - Country:US
Practice Address - Phone:918-341-1000
Practice Address - Fax:918-403-6309
Is Sole Proprietor?:No
Enumeration Date:2006-12-05
Last Update Date:2018-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK882363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant