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General NPI Number Information
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NPI Number | 1558384487
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Entity Type | Individual
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Provider Name | ANNE DOUGHERTY CRNP
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Gender | Female
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Dates
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Enumeration Date | 07/25/2006
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Last Update Date | 03/16/2023
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Provider Practice Location Address
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Address Line | 472 ROUTE 47
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City | SUGAR GROVE
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State | IL
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Zip | 60554-8107
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Country | US
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Telephone | 630-466-6000
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Fax |
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Provider Business Mailing Address
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Address Line | 1256 WATERFORD DR STE 230
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City | AURORA
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State | IL
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Zip | 60504-4511
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Country | US
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Telephone | 630-978-6204
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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 | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 209023170
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 333962
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License Number State | NY
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Taxonomy #3
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 209023170
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License Number State | IL
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Taxonomy #4
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | R171561
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License Number State | MD
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Taxonomy #5
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | SP006072B
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License Number State | PA
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