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NPI Code Detail

MEDICARE: RENEE M DOHERTY CNP

MEDICARE: RENEE M DOHERTY CNP
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
1363L00000XNurse Practitioner4704177783MI

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
14704177783OTHERMIMI STATE LICENSE

General Provider Information

NPI Number : 1891001681
Entity Type Code : Individual
Provider Name (Legal Business Name) : RENEE M DOHERTY CNP
Provider Business Mailing Address
First Line : 801 ROSEHILL RD
Second Line :
City : JACKSON
State : MI
Zip : 49202-1762
Country : US
Telephone Number : 989-633-1400
Fax Number : 517-212-2009
Provider Business Practice Location Address
First Line : 4760 FASHION SQUARE BLVD STE L-1
Second Line :
City : SAGINAW
State : MI
Zip : 48604-2620
Country : US
Telephone Number : 989-282-4003
Fax Number : 888-491-7220
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/31/2010
Last Update Date : 03/16/2023

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