Provider Demographics
NPI:1659922946
Name:DOLAN-BOSCHERT, ALLISON LEIGH (NP)
Entity Type:Individual
Prefix:
First Name:ALLISON
Middle Name:LEIGH
Last Name:DOLAN-BOSCHERT
Suffix:
Gender:F
Credentials:NP
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 445
Mailing Address - Street 2:
Mailing Address - City:SULLIVAN
Mailing Address - State:MO
Mailing Address - Zip Code:63080-0445
Mailing Address - Country:US
Mailing Address - Phone:314-881-0300
Mailing Address - Fax:314-881-0321
Practice Address - Street 1:3915 WATSON RD
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63109-1267
Practice Address - Country:US
Practice Address - Phone:314-881-0300
Practice Address - Fax:314-881-0321
Is Sole Proprietor?:No
Enumeration Date:2019-09-27
Last Update Date:2021-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2018036935363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner