Individual
DIANE ELAINE DOHERTY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
9098 W RIDGE LINE LN, COEUR D ALENE, ID 83814-9103
(208) 651-2186
(208) 769-7960
Mailing address
9098 W. RIDGE LINE, COEUR D ALENE, ID 83814-9103
(208) 651-2186
(208) 769-7960
Taxonomy
Speciality
Code
Description
License number
State
164X00000X
Licensed Vocational Nurse
Primary
VN 3801
CA
376K00000X
Nurse's Aide
—
ID
Other
Enumeration date
02/08/2010
Last updated
02/08/2010
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