Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NN0400X | Neurology | 038.013297 | IL |
NPI | 1073078861 |
---|---|
Provider Name | Dr. Holly Marie Doherty |
First Address | Bloomington, IL 61701-6103 |
Second Address | Gibson City, IL 60936-1659 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/02/2019 |
Last Update Date | 05/02/2019 |