Provider Demographics
NPI:1528809662
Name:DOOLEY, MIRANDA L (APNP)
Entity type:Individual
Prefix:
First Name:MIRANDA
Middle Name:L
Last Name:DOOLEY
Suffix:
Gender:F
Credentials:APNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20315 SUTTER CREEK DR APT 419
Mailing Address - Street 2:
Mailing Address - City:BROOKFIELD
Mailing Address - State:WI
Mailing Address - Zip Code:53045-3957
Mailing Address - Country:US
Mailing Address - Phone:414-581-4667
Mailing Address - Fax:
Practice Address - Street 1:2001 S CENTRAL AVE STE A
Practice Address - Street 2:
Practice Address - City:MARSHFIELD
Practice Address - State:WI
Practice Address - Zip Code:54449-4973
Practice Address - Country:US
Practice Address - Phone:715-384-2818
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-03
Last Update Date:2024-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI15404-33363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health