Provider Demographics
NPI:1649561630
Name:DOHERTY, LYNNE J (FNP)
Entity Type:Individual
Prefix:
First Name:LYNNE
Middle Name:J
Last Name:DOHERTY
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 LYNDON RD
Mailing Address - Street 2:
Mailing Address - City:WRENTHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02093-1155
Mailing Address - Country:US
Mailing Address - Phone:508-384-0505
Mailing Address - Fax:
Practice Address - Street 1:24 COMMON ST
Practice Address - Street 2:SUITE # 3
Practice Address - City:WRENTHAM
Practice Address - State:MA
Practice Address - Zip Code:02093-1399
Practice Address - Country:US
Practice Address - Phone:508-384-1821
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-04-25
Last Update Date:2011-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN196639363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily