Provider Demographics
NPI:1023040920
Name:DOUGHTY, LANA K (RNCS, APRN)
Entity Type:Individual
Prefix:
First Name:LANA
Middle Name:K
Last Name:DOUGHTY
Suffix:
Gender:F
Credentials:RNCS, APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 WHEELER ST
Mailing Address - Street 2:
Mailing Address - City:GLOUCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01930-1648
Mailing Address - Country:US
Mailing Address - Phone:978-337-2437
Mailing Address - Fax:
Practice Address - Street 1:125 LIBERTY ST
Practice Address - Street 2:STE 2
Practice Address - City:DANVERS
Practice Address - State:MA
Practice Address - Zip Code:01923-3325
Practice Address - Country:US
Practice Address - Phone:978-337-2437
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-07
Last Update Date:2017-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA121048364SP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SP0808XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1891561Medicaid
MA1891561Medicaid
MANS0185Medicare UPIN