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Individual
JENNIFER POTHOVEN DOUGHERTY
Active
Individual
JENNIFER POTHOVEN DOUGHERTY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Taxonomy
Speciality
Code
Description
License number
State
163WP0200X
Pediatric Registered Nurse
RN637152
PA
363LP0200X
Pediatric Nurse Practitioner
Primary
5008859
NC
363LP0200X
Pediatric Nurse Practitioner
SP013365
PA
Other
Enumeration date
11/03/2013
Last updated
05/09/2022
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