Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP2300X | Nurse Practitioner - Primary Care | RN.288485-COA 1 | OH |
NPI | 1093155673 |
---|---|
Provider Name | Cynthia Kathleen Doughty |
First Address | Columbus, OH 43235-4582 |
Second Address | Columbus, OH 43235-4582 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/06/2013 |
Last Update Date | 20/07/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0086421 | (05) | OH |