Provider Demographics
NPI:1780892711
Name:DOERR, MARY JO ANN (RNC, MSN, WHNP)
Entity type:Individual
Prefix:MS
First Name:MARY JO
Middle Name:ANN
Last Name:DOERR
Suffix:
Gender:F
Credentials:RNC, MSN, WHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11487 N SIX LAKES RD
Mailing Address - Street 2:
Mailing Address - City:SIX LAKES
Mailing Address - State:MI
Mailing Address - Zip Code:48886
Mailing Address - Country:US
Mailing Address - Phone:989-365-3637
Mailing Address - Fax:
Practice Address - Street 1:11487 N SIX LAKES RD
Practice Address - Street 2:
Practice Address - City:SIX LAKES
Practice Address - State:MI
Practice Address - Zip Code:48886
Practice Address - Country:US
Practice Address - Phone:989-365-3637
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704152127363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health