Healthcare Provider Details

I. General information

NPI: 1124551668
Provider Name (Legal Business Name): ALEXA STARR DOUGHERTY CNM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/11/2017
Last Update Date: 09/24/2026
Certification Date: 09/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

131 DODGE ST
BEVERLY MA
01915-2048
US

IV. Provider business mailing address

801 ALBANY STREET FL G
BOSTON MA
02119-3791
US

V. Phone/Fax

Practice location:
  • Phone: 781-883-6629
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number294219
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberCNM2300477
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: