Provider Demographics
NPI:1316969611
Name:DOUCETTE, CHERYL ANN (APRN, BC)
Entity type:Individual
Prefix:
First Name:CHERYL
Middle Name:ANN
Last Name:DOUCETTE
Suffix:
Gender:F
Credentials:APRN, BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 5
Mailing Address - Street 2:
Mailing Address - City:NORTH WOODSTOCK
Mailing Address - State:NH
Mailing Address - Zip Code:03262-0005
Mailing Address - Country:US
Mailing Address - Phone:603-728-8872
Mailing Address - Fax:603-945-8991
Practice Address - Street 1:21 MOUNTAIN PARK DRIVE
Practice Address - Street 2:
Practice Address - City:WOODSTOCK
Practice Address - State:NH
Practice Address - Zip Code:03262-0005
Practice Address - Country:US
Practice Address - Phone:603-728-8872
Practice Address - Fax:603-945-8991
Is Sole Proprietor?:No
Enumeration Date:2006-07-24
Last Update Date:2024-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA216207364SP0809X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SP0809XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health, Adult
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0701980Medicaid
NP2283Medicare ID - Type Unspecified