Provider Demographics
NPI:1417474214
Name:DOHERTY, SHERRY LYNN (RN)
Entity Type:Individual
Prefix:
First Name:SHERRY
Middle Name:LYNN
Last Name:DOHERTY
Suffix:
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 1:1855 S MAIN ST STE C
Mailing Address - Street 2:
Mailing Address - City:GOSHEN
Mailing Address - State:IN
Mailing Address - Zip Code:46526-4853
Mailing Address - Country:US
Mailing Address - Phone:574-364-2746
Mailing Address - Fax:574-364-1460
Practice Address - Street 1:1855 S MAIN ST STE C
Practice Address - Street 2:
Practice Address - City:GOSHEN
Practice Address - State:IN
Practice Address - Zip Code:46526-4853
Practice Address - Country:US
Practice Address - Phone:574-364-2746
Practice Address - Fax:574-364-1460
Is Sole Proprietor?:No
Enumeration Date:2017-08-23
Last Update Date:2017-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN28078391A163WD0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WD0400XNursing Service ProvidersRegistered NurseDiabetes Educator