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Individual

DONNA JEAN DOHERTY

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F
Credential
AGNP-BC

Contact information

Practice address
3003 NEW HYDE PARK RD, NEW HYDE PARK, NY 11042-1206
(516) 327-0001
Mailing address
3003 NEW HYDE PARK RD, NEW HYDE PARK, NY 11042-1206
(516) 327-0001

Taxonomy

Speciality
Code
Description
License number
State
363LG0600X
Gerontology Nurse Practitioner
Primary
309821
NY

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
309821
NYS LICENSE
NY
Enumeration date
08/12/2020
Last updated
11/27/2023
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