Provider Demographics
NPI:1508105552
Name:DOTSON, MARIEA D (LPN)
Entity Type:Individual
Prefix:MS
First Name:MARIEA
Middle Name:D
Last Name:DOTSON
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3952 CYPRESS AVE
Mailing Address - Street 2:
Mailing Address - City:GROVE CITY
Mailing Address - State:OH
Mailing Address - Zip Code:43123-9676
Mailing Address - Country:US
Mailing Address - Phone:614-962-1347
Mailing Address - Fax:
Practice Address - Street 1:3952 CYPRESS AVE
Practice Address - Street 2:
Practice Address - City:GROVE CITY
Practice Address - State:OH
Practice Address - Zip Code:43123-9676
Practice Address - Country:US
Practice Address - Phone:614-962-1347
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-12
Last Update Date:2013-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH136387164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse