Provider Demographics
NPI:1912487794
Name:JARR, ELIZABETH DOUGHERTY (REGISTERED NURSE)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:DOUGHERTY
Last Name:JARR
Suffix:
Gender:F
Credentials:REGISTERED NURSE
Other - Prefix:
Other - First Name:ELIZABETH
Other - Middle Name:BURKE
Other - Last Name:DOUGHERTY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:REGISTERED NURSE
Mailing Address - Street 1:5 SHERIDAN ST
Mailing Address - Street 2:APARTMENT 1
Mailing Address - City:JAMAICA PLAIN
Mailing Address - State:MA
Mailing Address - Zip Code:02130
Mailing Address - Country:US
Mailing Address - Phone:415-250-6996
Mailing Address - Fax:
Practice Address - Street 1:360 MERRIMACK ST STE 5
Practice Address - Street 2:
Practice Address - City:LAWRENCE
Practice Address - State:MA
Practice Address - Zip Code:01843-1740
Practice Address - Country:US
Practice Address - Phone:978-688-4830
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-21
Last Update Date:2018-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN2311591163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse