Individual
IAN DOHERTY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
1 ELLIOT WAY STE 200, MANCHESTER, NH 03103-3502
(603) 663-2315
Mailing address
PROVIDER ENROLLMENT 41 MALL ROAD, BURLINGTON, MA 01805-0001
(781) 744-8085
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
086161-23
NH
367500000X
Certified Registered Nurse Anesthetist
Primary
RN2304236
MA
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
05/24/2021
Last updated
05/08/2023
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