Provider Demographics
NPI:1861728834
Name:HOOLEY, ELIZABETH DOROTHEA (PHYSICIAN ASSISTANT)
Entity type:Individual
Prefix:MRS
First Name:ELIZABETH
Middle Name:DOROTHEA
Last Name:HOOLEY
Suffix:
Gender:F
Credentials:PHYSICIAN ASSISTANT
Other - Prefix:MS
Other - First Name:ELIZABETH
Other - Middle Name:DOROTHEA
Other - Last Name:CARLISLE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHYSICIAN ASSISTANT
Mailing Address - Street 1:601 JOHN ST
Mailing Address - Street 2:SUITE W308
Mailing Address - City:KALAMAZOO
Mailing Address - State:MI
Mailing Address - Zip Code:49007-5341
Mailing Address - Country:US
Mailing Address - Phone:269-341-8827
Mailing Address - Fax:269-341-7518
Practice Address - Street 1:601 JOHN ST
Practice Address - Street 2:SUITE W308
Practice Address - City:KALAMAZOO
Practice Address - State:MI
Practice Address - Zip Code:49007-5341
Practice Address - Country:US
Practice Address - Phone:269-341-8827
Practice Address - Fax:269-341-7518
Is Sole Proprietor?:No
Enumeration Date:2009-10-27
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL085.003561363A00000X
MI5601006625363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant