Healthcare Provider Details

I. General information

NPI: 1023040920
Provider Name (Legal Business Name): LANA K DOUGHTY RNCS, APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/07/2006
Last Update Date: 11/29/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

125 LIBERTY ST STE 2
DANVERS MA
01923-3325
US

IV. Provider business mailing address

120 WHEELER ST
GLOUCESTER MA
01930-1648
US

V. Phone/Fax

Practice location:
  • Phone: 978-337-2437
  • Fax:
Mailing address:
  • Phone: 978-337-2437
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364SP0808X
TaxonomyPsychiatric/Mental Health Clinical Nurse Specialist
License Number121048
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: