Provider Demographics
NPI:1285909572
Name:DOHERTY, KATHLEEN CHRISTINA (REGISTERED NURSE)
Entity type:Individual
Prefix:MRS
First Name:KATHLEEN
Middle Name:CHRISTINA
Last Name:DOHERTY
Suffix:
Gender:F
Credentials:REGISTERED NURSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:212 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:NY
Mailing Address - Zip Code:10950-2845
Mailing Address - Country:US
Mailing Address - Phone:845-460-6800
Mailing Address - Fax:845-460-6038
Practice Address - Street 1:212 N MAIN ST
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:NY
Practice Address - Zip Code:10950-2845
Practice Address - Country:US
Practice Address - Phone:845-460-6800
Practice Address - Fax:845-460-6038
Is Sole Proprietor?:No
Enumeration Date:2012-03-20
Last Update Date:2012-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY22454430163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool