Provider Demographics
NPI:1508973801
Name:DOUGHERTY, JUNE B (RN)
Entity Type:Individual
Prefix:MRS
First Name:JUNE
Middle Name:B
Last Name:DOUGHERTY
Suffix:
Gender:F
Credentials:RN
Other - Prefix:MRS
Other - First Name:JUNE
Other - Middle Name:B
Other - Last Name:CARIBOU
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RN
Mailing Address - Street 1:3600 TOWER AVE
Mailing Address - Street 2:SUITE ONE
Mailing Address - City:SUPERIOR
Mailing Address - State:WI
Mailing Address - Zip Code:54880-5337
Mailing Address - Country:US
Mailing Address - Phone:715-392-1955
Mailing Address - Fax:715-392-1935
Practice Address - Street 1:3600 TOWER AVE
Practice Address - Street 2:SUITE ONE
Practice Address - City:SUPERIOR
Practice Address - State:WI
Practice Address - Zip Code:54880-5337
Practice Address - Country:US
Practice Address - Phone:715-392-1955
Practice Address - Fax:715-392-1935
Is Sole Proprietor?:No
Enumeration Date:2006-08-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI163WP2201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP2201XNursing Service ProvidersRegistered NurseAmbulatory Care