Individual
CRYSTAL R DOUGHERTY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RN
Contact information
Practice address
31 MARK DR, HOLBROOK, NY 11741-5810
(631) 882-7418
Mailing address
74 GLEN SUMMER RD, HOLBROOK, NY 11741-5008
(631) 609-0629
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
612980-1
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
612980-1
—
NY
Enumeration date
04/20/2009
Last updated
11/20/2017
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