Provider Demographics
NPI:1972972180
Name:DOLAN, SUSAN J (PA)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:J
Last Name:DOLAN
Suffix:
Gender:F
Credentials:PA
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Mailing Address - Street 1:300 N WILLSON AVE
Mailing Address - Street 2:STE 2001
Mailing Address - City:BOZEMAN
Mailing Address - State:MT
Mailing Address - Zip Code:59715-3572
Mailing Address - Country:US
Mailing Address - Phone:406-587-0681
Mailing Address - Fax:406-587-9011
Practice Address - Street 1:300 N WILLSON AVE
Practice Address - Street 2:STE 2001
Practice Address - City:BOZEMAN
Practice Address - State:MT
Practice Address - Zip Code:59715-3572
Practice Address - Country:US
Practice Address - Phone:406-587-0681
Practice Address - Fax:406-587-9011
Is Sole Proprietor?:No
Enumeration Date:2015-09-17
Last Update Date:2015-09-17
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MT42320363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical