Provider Demographics
NPI:1447657630
Name:DOUGHERTY, DEBORAH (CRNP)
Entity type:Individual
Prefix:
First Name:DEBORAH
Middle Name:
Last Name:DOUGHERTY
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2510 BONA RD
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19810-2220
Mailing Address - Country:US
Mailing Address - Phone:302-893-2216
Mailing Address - Fax:215-707-4328
Practice Address - Street 1:2510 BONA RD
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19810-2220
Practice Address - Country:US
Practice Address - Phone:302-893-2216
Practice Address - Fax:215-707-4328
Is Sole Proprietor?:Yes
Enumeration Date:2014-12-03
Last Update Date:2014-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP014514363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily