MEDICARE: MS. MARY ELLEN DOOLEY MSN,N.P.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	68411	CO

General Provider Information

NPI Number	:	1811109515
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. MARY ELLEN DOOLEY MSN,N.P.

Provider Business Mailing Address
First Line	:	3980 BROADWAY ST
Second Line	:	103-137
City	:	BOULDER
State	:	CO
Zip	:	80304-1133
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	777 BANNOCK ST
Second Line	:	MC 3240
City	:	DENVER
State	:	CO
Zip	:	80204-4507
Country	:	US
Telephone Number	:	303-436-6000
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/04/2007
Last Update Date	:	03/30/2021

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