Healthcare Provider Details

I. General information

NPI: 1053706275
Provider Name (Legal Business Name): MELANIE DOUGHERTY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/03/2015
Last Update Date: 04/03/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

140 MICHIGAN AVE W
BATTLE CREEK MI
49017-3602
US

IV. Provider business mailing address

140 MICHIGAN AVE W
BATTLE CREEK MI
49017-3602
US

V. Phone/Fax

Practice location:
  • Phone: 269-966-1460
  • Fax: 269-979-7766
Mailing address:
  • Phone: 269-966-1460
  • Fax: 269-979-7766

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License Number4704252862
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: