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General NPI Number Information
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NPI Number | 1003163577
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Entity Type | Individual
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Provider Name | BARBARA DOUGHERTY CRNP
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Gender | Female
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Dates
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Enumeration Date | 08/14/2012
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Last Update Date | 12/16/2020
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Provider Practice Location Address
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Address Line | 125 E ELM ST STE 201
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City | CONSHOHOCKEN
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State | PA
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Zip | 19428-4150
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Country | US
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Telephone | 877-278-3697
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Fax | 610-910-3890
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Provider Business Mailing Address
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Address Line | 7863 SPRING AVE
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City | ELKINS PARK
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State | PA
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Zip | 19027-2619
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | SP011901
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License Number State | PA
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