Healthcare Provider Details

I. General information

NPI: 1730433970
Provider Name (Legal Business Name): JANE MARY DOHERTY NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/08/2012
Last Update Date: 12/10/2025
Certification Date: 12/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

253 PLEASANT ST
CONCORD NH
03301-7560
US

IV. Provider business mailing address

1 MEDICAL CENTER DR DHMC
LEBANON NH
03756-1000
US

V. Phone/Fax

Practice location:
  • Phone: 603-226-6108
  • Fax: 603-640-1228
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LC1500X
TaxonomyCommunity Health Nurse Practitioner
License Number066954-23
License Number StateNH
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number066954-23
License Number StateNH
# 3
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number066954-21
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: