Healthcare Provider Details

I. General information

NPI: 1104617984
Provider Name (Legal Business Name): ROSEMARIE DOHERTY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/13/2025
Last Update Date: 05/19/2025
Certification Date: 05/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

560 COHASSET RD STE 175
CHICO CA
95926-2460
US

IV. Provider business mailing address

PO BOX 383
LAKEPORT CA
95453-0383
US

V. Phone/Fax

Practice location:
  • Phone: 530-891-2810
  • Fax:
Mailing address:
  • Phone: 619-301-2572
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License Number95203830
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: