Healthcare Provider Details

I. General information

NPI: 1134470891
Provider Name (Legal Business Name): GERALDINE M DOUGHERTY R.N.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/20/2012
Last Update Date: 09/20/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

190 WASHINGTON AVE
BATAVIA NY
14020-2113
US

IV. Provider business mailing address

6043 MAIN RD
STAFFORD NY
14143-9519
US

V. Phone/Fax

Practice location:
  • Phone: 585-344-1227
  • Fax:
Mailing address:
  • Phone: 585-330-1462
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364S00000X
TaxonomyClinical Nurse Specialist
License Number131069-J
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: