Provider Demographics
NPI:1184652968
Name:DOUGHTY, SUSAN EMILY DAVIS (WHNP C)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:EMILY DAVIS
Last Name:DOUGHTY
Suffix:
Gender:F
Credentials:WHNP C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:260 WESTERN AVENUE
Mailing Address - Street 2:
Mailing Address - City:SOUTH PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04106
Mailing Address - Country:US
Mailing Address - Phone:207-761-4700
Mailing Address - Fax:217-761-4744
Practice Address - Street 1:260 WESTERN AVENUE
Practice Address - Street 2:NEW ENGLAND WOMEN CENTER
Practice Address - City:SOUTH PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04106
Practice Address - Country:US
Practice Address - Phone:207-761-4700
Practice Address - Fax:217-761-4744
Is Sole Proprietor?:No
Enumeration Date:2006-06-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MER027192363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NG0088Medicare ID - Type Unspecified
S32223Medicare UPIN