Healthcare Provider Details

I. General information

NPI: 1659866044
Provider Name (Legal Business Name): ELIZABETH E DOLAN PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ELIZABETH EMMERICH

II. Dates (important events)

Enumeration Date: 06/27/2018
Last Update Date: 08/04/2021
Certification Date: 08/04/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

750 UNIVERSITY ROW
MADISON WI
53705-1311
US

IV. Provider business mailing address

7974 UW HEALTH CT
MIDDLETON WI
53562-5531
US

V. Phone/Fax

Practice location:
  • Phone: 608-890-5090
  • Fax:
Mailing address:
  • Phone: 608-829-5485
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number4394
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number4394
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: