Healthcare Provider Details

I. General information

NPI: 1518843846
Provider Name (Legal Business Name): DEVON VERONICA DOUGHERTY RN, ACCNS-P
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/13/2025
Last Update Date: 10/08/2026
Certification Date: 10/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3401 CIVIC CENTER BLVD
PHILADELPHIA PA
19104-4319
US

IV. Provider business mailing address

62 HAINES MILL RD
DELRAN NJ
08075-1737
US

V. Phone/Fax

Practice location:
  • Phone: 445-800-7994
  • Fax:
Mailing address:
  • Phone: 445-800-7994
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364SP0200X
TaxonomyPediatric Clinical Nurse Specialist
License NumberCNS000415
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code163WP0200X
TaxonomyPediatric Registered Nurse
License NumberRN735306
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: