Provider Demographics
NPI:1285744169
Name:DOUGHER, MARILYN J (RNC)
Entity type:Individual
Prefix:
First Name:MARILYN
Middle Name:J
Last Name:DOUGHER
Suffix:
Gender:F
Credentials:RNC
Other - Prefix:
Other - First Name:MARILYN
Other - Middle Name:J
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:8290 OPAL DRIVE
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99502-4546
Mailing Address - Country:US
Mailing Address - Phone:907-243-2259
Mailing Address - Fax:
Practice Address - Street 1:3200 PROVIDENCE DR
Practice Address - Street 2:PROVIDENCE ALASKA MEDICAL CENTER
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99508-4615
Practice Address - Country:US
Practice Address - Phone:907-562-2211
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2009-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AKAK 10505163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse