Provider Demographics
NPI:1457043465
Name:DOTSON, ELIZABETH C (PMHNP)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:C
Last Name:DOTSON
Suffix:
Gender:F
Credentials:PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3787 RIVER RD N STE A
Mailing Address - Street 2:
Mailing Address - City:KEIZER
Mailing Address - State:OR
Mailing Address - Zip Code:97303-4899
Mailing Address - Country:US
Mailing Address - Phone:971-312-7163
Mailing Address - Fax:503-506-0495
Practice Address - Street 1:3787 RIVER RD N STE A
Practice Address - Street 2:
Practice Address - City:KEIZER
Practice Address - State:OR
Practice Address - Zip Code:97303-4899
Practice Address - Country:US
Practice Address - Phone:971-312-7163
Practice Address - Fax:503-506-0495
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-26
Last Update Date:2023-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR10008925363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health