Provider Demographics
NPI:1609003722
Name:DOUGHERTY, DONA MAE (NP-C)
Entity Type:Individual
Prefix:
First Name:DONA
Middle Name:MAE
Last Name:DOUGHERTY
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:MRS
Other - First Name:DONA
Other - Middle Name:MAE
Other - Last Name:MAUS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:13820 N 51ST AVE
Mailing Address - Street 2:#400
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85306-4885
Mailing Address - Country:US
Mailing Address - Phone:602-938-2300
Mailing Address - Fax:602-938-1724
Practice Address - Street 1:13820 N 51ST AVE
Practice Address - Street 2:#400
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85306-4885
Practice Address - Country:US
Practice Address - Phone:602-938-2300
Practice Address - Fax:602-938-1724
Is Sole Proprietor?:No
Enumeration Date:2009-06-16
Last Update Date:2009-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ253363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health