Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP0200X | Nurse Practitioner - Pediatrics | 201706329NP | OR |
N | 363LP0200X | Nurse Practitioner - Pediatrics | 271206 | MA |
NPI | 1033470646 |
---|---|
Provider Name | Chelsea Doherty |
First Address | Portland, OR 97224-6039 |
Second Address | Portland, OR 97224 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/05/2012 |
Last Update Date | 16/05/2018 |