Provider Demographics
NPI:1588990535
Name:DOLAN, ADRIENNE CASTILLE (PA-C)
Entity type:Individual
Prefix:
First Name:ADRIENNE
Middle Name:CASTILLE
Last Name:DOLAN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:ADRIENNE
Other - Middle Name:ROSE
Other - Last Name:CASTILLE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:7777 HENNESSY BLVD STE 1008
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70808-4368
Mailing Address - Country:US
Mailing Address - Phone:225-766-0416
Mailing Address - Fax:
Practice Address - Street 1:7777 HENNESSY BLVD -- ER DEPT
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70808
Practice Address - Country:US
Practice Address - Phone:225-765-8826
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-10-27
Last Update Date:2023-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAPA.200326363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA2312707Medicaid
LA2312707Medicaid