Provider Demographics
NPI:1083117592
Name:DOUGHERTY, LOUISE CHRISTINE I (RN)
Entity Type:Individual
Prefix:
First Name:LOUISE
Middle Name:CHRISTINE
Last Name:DOUGHERTY
Suffix:I
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6412 OCEAN AVE NORTH
Mailing Address - Street 2:
Mailing Address - City:ARVERNE
Mailing Address - State:NY
Mailing Address - Zip Code:11692
Mailing Address - Country:US
Mailing Address - Phone:646-469-3059
Mailing Address - Fax:718-758-7607
Practice Address - Street 1:6412 OCEAN AVE NORTH
Practice Address - Street 2:
Practice Address - City:ARVERNE
Practice Address - State:NY
Practice Address - Zip Code:11692
Practice Address - Country:US
Practice Address - Phone:646-469-3059
Practice Address - Fax:718-758-7607
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-10
Last Update Date:2018-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY360447163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY360447OtherRN LICENCE