Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LC1500X | Nurse Practitioner - Community Health | 066954-23 | NH |
N | 363LF0000X | Nurse Practitioner - Family Medicine | 066954-23 | NH |
NPI | 1730433970 |
---|---|
Provider Name | Jane Mary Doherty |
First Address | Lebanon, NH 03756-1000 |
Second Address | Concord, NH 03301-7560 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/11/2012 |
Last Update Date | 01/03/2019 |