Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LC0200X | Nurse Practitioner - Critical Care Medicine | 0027913 | OH |
NPI | 1346912433 |
---|---|
Provider Name | Melissa Ann Doughty |
First Address | West Springfield, PA 16443-9447 |
Second Address | Beachwood, OH 44122-6046 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 28/09/2021 |
Last Update Date | 28/09/2021 |