Provider Demographics
NPI:1497700652
Name:DOHERTY, LISA M (APRN, BC)
Entity Type:Individual
Prefix:MRS
First Name:LISA
Middle Name:M
Last Name:DOHERTY
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Gender:F
Credentials:APRN, BC
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Mailing Address - Street 1:450 BROOKLINE AVE
Mailing Address - Street 2:DA2116
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02215-5418
Mailing Address - Country:US
Mailing Address - Phone:617-632-5925
Mailing Address - Fax:617-632-4773
Practice Address - Street 1:450 BROOKLINE AVE
Practice Address - Street 2:DA2116
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02215-5418
Practice Address - Country:US
Practice Address - Phone:617-632-5925
Practice Address - Fax:617-632-4773
Is Sole Proprietor?:No
Enumeration Date:2006-05-24
Last Update Date:2013-08-28
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Provider Licenses
StateLicense IDTaxonomies
MA229154363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health