MEDICARE: DEBORAH DOUGHERTY NP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363L00000X	Nurse Practitioner	71000704	IN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1871670372
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DEBORAH DOUGHERTY NP

Provider Business Mailing Address
First Line	:	520 TRACY RD
Second Line	:
City	:	NEW WHITELAND
State	:	IN
Zip	:	46184-9373
Country	:	US
Telephone Number	:	317-535-7447
Fax Number	:

Provider Business Practice Location Address
First Line	:	520 TRACY RD
Second Line	:
City	:	NEW WHITELAND
State	:	IN
Zip	:	46184-9373
Country	:	US
Telephone Number	:	317-535-7447
Fax Number	:	317-535-0262

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/01/2006
Last Update Date	:	04/21/2010

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