Provider Demographics
NPI:1275102667
Name:DOHERTY, STEPHANIE A (NP)
Entity Type:Individual
Prefix:MRS
First Name:STEPHANIE
Middle Name:A
Last Name:DOHERTY
Suffix:
Gender:F
Credentials:NP
Other - Prefix:MS
Other - First Name:STEPHANIE
Other - Middle Name:A
Other - Last Name:HENDLEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:4 COURTHOUSE LN STE 9
Mailing Address - Street 2:
Mailing Address - City:CHELMSFORD
Mailing Address - State:MA
Mailing Address - Zip Code:01824-1731
Mailing Address - Country:US
Mailing Address - Phone:978-459-8400
Mailing Address - Fax:
Practice Address - Street 1:4 COURTHOUSE LN STE 9
Practice Address - Street 2:
Practice Address - City:CHELMSFORD
Practice Address - State:MA
Practice Address - Zip Code:01824-1731
Practice Address - Country:US
Practice Address - Phone:978-459-8400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-21
Last Update Date:2022-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN2313731163W00000X, 363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
No163W00000XNursing Service ProvidersRegistered Nurse