Provider Demographics
NPI:1083859839
Name:DAUGHERTY, CAROL A (NP)
Entity Type:Individual
Prefix:MS
First Name:CAROL
Middle Name:A
Last Name:DAUGHERTY
Suffix:
Gender:F
Credentials:NP
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Mailing Address - Street 1:67 UNION ST
Mailing Address - Street 2:SUITE 308
Mailing Address - City:NATICK
Mailing Address - State:MA
Mailing Address - Zip Code:01760-7700
Mailing Address - Country:US
Mailing Address - Phone:508-655-4422
Mailing Address - Fax:508-655-9191
Practice Address - Street 1:67 UNION ST
Practice Address - Street 2:SUITE 308
Practice Address - City:NATICK
Practice Address - State:MA
Practice Address - Zip Code:01760-7700
Practice Address - Country:US
Practice Address - Phone:508-655-4422
Practice Address - Fax:508-655-9191
Is Sole Proprietor?:No
Enumeration Date:2008-12-09
Last Update Date:2015-07-28
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA226738363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner