Individual
LAURIE L DOUGHERTY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRNP
Contact information
Practice address
3400 SPRUCE ST, PHILADELPHIA, PA 19104-4206
(215) 662-4000
(215) 463-3820
Mailing address
3400 SPRUCE ST, PHILADELPHIA, PA 19104-4206
(215) 662-4000
(215) 745-4749
Taxonomy
Speciality
Code
Description
License number
State
363LA2200X
Adult Health Nurse Practitioner
Primary
SP007792
PA
Other
Enumeration date
06/22/2006
Last updated
12/29/2011
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