Individual
MARY ELLEN DOHERTY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RN
Contact information
Practice address
401 CYPRESS ST, MANCHESTER, NH 03103-3628
(603) 668-4111
Mailing address
401 CYPRESS ST, MANCHESTER, NH 03103-3628
(603) 668-4111
Taxonomy
Speciality
Code
Description
License number
State
163WP0808X
Psychiatric/Mental Health Registered Nurse
Primary
030792-21
NH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
7706660Y0NH01
BLUE CROSS
NH
Enumeration date
12/19/2006
Last updated
07/08/2007
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