Individual
GIANISA NICOLE DOUGHERTY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
ATC
Contact information
Practice address
650 LEM MORRISON DRIVE, AUBRUN, AL 36830
(224) 523-0191
Mailing address
10012 THORNTON WAY APT SUITE, HUNTLEY, IL 60142-2390
(224) 523-0191
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
—
—
Other
Enumeration date
08/31/2021
Last updated
08/31/2021
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