Provider Demographics
NPI:1568403384
Name:DOYLE, MARY ELAINE (RN, BC, M)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:ELAINE
Last Name:DOYLE
Suffix:
Gender:F
Credentials:RN, BC, M
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 104240
Mailing Address - Street 2:
Mailing Address - City:JEFFERSON CITY
Mailing Address - State:MO
Mailing Address - Zip Code:65110-4240
Mailing Address - Country:US
Mailing Address - Phone:573-635-5264
Mailing Address - Fax:
Practice Address - Street 1:701 W HIGH ST
Practice Address - Street 2:
Practice Address - City:JEFFERSON CITY
Practice Address - State:MO
Practice Address - Zip Code:65101-1525
Practice Address - Country:US
Practice Address - Phone:573-636-3313
Practice Address - Fax:573-636-5881
Is Sole Proprietor?:No
Enumeration Date:2006-06-10
Last Update Date:2011-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO049703363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner