Healthcare Provider Details

I. General information

NPI: 1891605879
Provider Name (Legal Business Name): MARIAN DOVER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MARIAN QUALLS

II. Dates (important events)

Enumeration Date: 09/10/2026
Last Update Date: 09/10/2026
Certification Date: 09/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

461 PROVIDENCE DR
PROSPER TX
75078-8008
US

IV. Provider business mailing address

461 PROVIDENCE DR
PROSPER TX
75078-8008
US

V. Phone/Fax

Practice location:
  • Phone: 314-276-1254
  • Fax:
Mailing address:
  • Phone: 314-276-1254
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number1116561
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: