Provider Demographics
NPI:1245531045
Name:DOLAN, MARY ALOYSIA (ARNP)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:ALOYSIA
Last Name:DOLAN
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:4401 BRIDGEPORT WAY W
Mailing Address - Street 2:
Mailing Address - City:UNIVERSITY PLACE
Mailing Address - State:WA
Mailing Address - Zip Code:98466-4201
Mailing Address - Country:US
Mailing Address - Phone:253-564-4157
Mailing Address - Fax:253-564-4813
Practice Address - Street 1:4401 BRIDGEPORT WAY W
Practice Address - Street 2:
Practice Address - City:UNIVERSITY PLACE
Practice Address - State:WA
Practice Address - Zip Code:98466-4201
Practice Address - Country:US
Practice Address - Phone:253-564-4157
Practice Address - Fax:253-564-4813
Is Sole Proprietor?:No
Enumeration Date:2010-11-10
Last Update Date:2016-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP60186964363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAG8903275Medicare PIN