Provider Demographics
NPI:1578169330
Name:DOUGHERTY, ERICA ENGLISH (CRNP)
Entity Type:Individual
Prefix:MRS
First Name:ERICA
Middle Name:ENGLISH
Last Name:DOUGHERTY
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:ERICA
Other - Middle Name:
Other - Last Name:ENGLISH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:33 SOUTH 9TH STREET
Mailing Address - Street 2:SUITE 740
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19107
Mailing Address - Country:US
Mailing Address - Phone:215-955-6680
Mailing Address - Fax:
Practice Address - Street 1:33 SOUTH 9TH STREET
Practice Address - Street 2:SUITE 740
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19107
Practice Address - Country:US
Practice Address - Phone:215-955-6680
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-08
Last Update Date:2021-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP022720363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner