Healthcare Provider Details

I. General information

NPI: 1386013340
Provider Name (Legal Business Name): ANGELA DOUGHERTY CNS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/21/2015
Last Update Date: 06/02/2026
Certification Date: 06/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1180 NEWFIELD AVE
STAMFORD CT
06905-1409
US

IV. Provider business mailing address

EVANS ARMY HOSPITAL 1650 COCHRAN CIRCLE
FORT CARSON CO
80913
US

V. Phone/Fax

Practice location:
  • Phone: 888-822-8436
  • Fax: 844-689-5311
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPN.1000607-NP
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code364SC0200X
TaxonomyCritical Care Medicine Clinical Nurse Specialist
License Number116443
License Number StateCO
# 3
Primary TaxonomyN
Taxonomy Code364SA2100X
TaxonomyAcute Care Clinical Nurse Specialist
License NumberAPN.0004988-CNS
License Number StateCO
# 4
Primary TaxonomyN
Taxonomy Code364SA2200X
TaxonomyAdult Health Clinical Nurse Specialist
License NumberAPN.0004988-CNS
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: