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General NPI Number Information
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NPI Number | 1649561630
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Entity Type | Individual
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Provider Name | LYNNE J DOHERTY FNP
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Gender | Female
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Dates
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Enumeration Date | 04/25/2011
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Last Update Date | 04/25/2011
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Provider Practice Location Address
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Address Line | 24 COMMON ST SUITE # 3
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City | WRENTHAM
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State | MA
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Zip | 02093-1399
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Country | US
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Telephone | 508-384-1821
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Fax |
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Provider Business Mailing Address
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Address Line | 20 LYNDON RD
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City | WRENTHAM
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State | MA
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Zip | 02093-1155
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Country | US
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Telephone | 508-384-0505
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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 | RN196639
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License Number State | MA
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