Basic Information
Provider Information
NPI: 1487942322
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: DOBBS
FirstName: MARY
MiddleName: FRANCES
NamePrefix:  
NameSuffix:  
Credential: NP
OtherOrganizationName:  
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OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
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OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 24 FRANK LLOYD WRIGHT DR
Address2: PO BOX 0446 LOBBY J
City: ANN ARBOR
State: MI
PostalCode: 481059484
CountryCode: US
TelephoneNumber: 7347476766
FaxNumber: 7342223100
Practice Location
Address1: 4350 JACKSON RD
Address2: STE 100
City: ANN ARBOR
State: MI
PostalCode: 481031889
CountryCode: US
TelephoneNumber: 7349719344
FaxNumber: 7349712303
Other Information
ProviderEnumerationDate: 07/13/2011
LastUpdateDate: 12/28/2016
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
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AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
363LP0200X4704181190MIY Physician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics

No ID Information.


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