Provider Demographics
NPI:1861817314
Name:DOERING, MISTY ROSE (APRN)
Entity Type:Individual
Prefix:
First Name:MISTY
Middle Name:ROSE
Last Name:DOERING
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:MISTY
Other - Middle Name:ROSE
Other - Last Name:ADAMS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:39 NOTT HWY UNIT 4
Mailing Address - Street 2:
Mailing Address - City:ASHFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06278-1341
Mailing Address - Country:US
Mailing Address - Phone:860-840-1058
Mailing Address - Fax:855-803-8591
Practice Address - Street 1:39 NOTT HWY UNIT 4
Practice Address - Street 2:
Practice Address - City:ASHFORD
Practice Address - State:CT
Practice Address - Zip Code:06278-1341
Practice Address - Country:US
Practice Address - Phone:860-840-1058
Practice Address - Fax:860-254-6026
Is Sole Proprietor?:No
Enumeration Date:2014-02-20
Last Update Date:2023-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT005619363L00000X, 364SA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SA2200XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistAdult Health
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner