Individual
MS. NINA DOUGHERTY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
28 GENERAL SAGE DR, SANTA FE, NM 87505-6395
(505) 988-1899
(505) 988-1899
Mailing address
28 GENERAL SAGE DR, SANTA FE, NM 87505-6395
(505) 988-1899
(505) 988-1899
Taxonomy
Speciality
Code
Description
License number
State
133VN1004X
Pediatric Nutrition Registered Dietitian
Primary
054
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
001179553000
CRS-1FILER'S KIT
NM
Enumeration date
06/20/2007
Last updated
07/08/2007
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