Healthcare Provider Details

I. General information

NPI: 1699334136
Provider Name (Legal Business Name): JAMIE LEE DOHERTY LPN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: JAMIE LEE EURE LPN

II. Dates (important events)

Enumeration Date: 06/09/2019
Last Update Date: 06/09/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 PEGASUS CT
WINCHESTER VA
22602-4596
US

IV. Provider business mailing address

130 TRAVIS CT
WINCHESTER VA
22602-4478
US

V. Phone/Fax

Practice location:
  • Phone: 540-313-4196
  • Fax:
Mailing address:
  • Phone: 540-931-7039
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License Number0002035859
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: