Individual
KELLIE JO DOUGHERTY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
146 N WESTERN AVE UNIT G, NEENAH, WI 54956-2297
(920) 410-9605
Mailing address
146 N WESTERN AVE UNIT G, NEENAH, WI 54956-2297
(920) 410-9605
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
174687
WI
163W00000X
Registered Nurse
95133947
CA
Other
Enumeration date
04/17/2019
Last updated
04/17/2019
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