Individual
RENEE M DOHERTY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
CNP
Contact information
Practice address
4760 FASHION SQUARE BLVD STE L-1, SAGINAW, MI 48604-2620
(989) 282-4003
(888) 491-7220
Mailing address
801 ROSEHILL RD, JACKSON, MI 49202-1762
(989) 633-1400
(517) 212-2009
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
4704177783
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
4704177783
MI STATE LICENSE
MI
Enumeration date
08/31/2010
Last updated
03/16/2023
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