Healthcare Provider Details

I. General information

NPI: 1508973801
Provider Name (Legal Business Name): JUNE B. DOUGHERTY RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JUNE B. CARIBOU RN

II. Dates (important events)

Enumeration Date: 08/23/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3600 TOWER AVE SUITE ONE
SUPERIOR WI
54880-5337
US

IV. Provider business mailing address

3600 TOWER AVE SUITE ONE
SUPERIOR WI
54880-5337
US

V. Phone/Fax

Practice location:
  • Phone: 715-392-1955
  • Fax: 715-392-1935
Mailing address:
  • Phone: 715-392-1955
  • Fax: 715-392-1935

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP2201X
TaxonomyAmbulatory Care Registered Nurse
License Number
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: