Provider Demographics
NPI:1962627232
Name:DOLL, SUSANA (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:SUSANA
Middle Name:
Last Name:DOLL
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12108 PARK AVE
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98447-0001
Mailing Address - Country:US
Mailing Address - Phone:253-535-7337
Mailing Address - Fax:253-536-5042
Practice Address - Street 1:12108 PARK AVE
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98447-0001
Practice Address - Country:US
Practice Address - Phone:253-535-7337
Practice Address - Fax:253-536-5042
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program