Provider Demographics
NPI:1316136625
Name:DODSON, MARY (CRNP)
Entity type:Individual
Prefix:MRS
First Name:MARY
Middle Name:
Last Name:DODSON
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 NOTTINGHAM DR
Mailing Address - Street 2:
Mailing Address - City:WEST GROVE
Mailing Address - State:PA
Mailing Address - Zip Code:19390-9738
Mailing Address - Country:US
Mailing Address - Phone:302-740-5396
Mailing Address - Fax:610-869-2643
Practice Address - Street 1:2 NOTTINGHAM DR
Practice Address - Street 2:
Practice Address - City:WEST GROVE
Practice Address - State:PA
Practice Address - Zip Code:19390-9738
Practice Address - Country:US
Practice Address - Phone:302-740-5396
Practice Address - Fax:610-869-2643
Is Sole Proprietor?:No
Enumeration Date:2007-10-23
Last Update Date:2020-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAUP003235B363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner