Individual
LISA DIANNE DOHERTY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
RN, BSN
Contact information
Practice address
4080 REED RD SE, SALEM, OR 97302-1357
(503) 507-0013
(503) 961-1283
Mailing address
5174 PERRY ST NE, KEIZER, OR 97303-2496
(503) 507-0013
(503) 961-1283
Taxonomy
Speciality
Code
Description
License number
State
163WC1500X
Community Health Registered Nurse
Primary
201240192RN
OR
Other
Enumeration date
08/29/2016
Last updated
08/29/2016
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