Provider Demographics
NPI:1427423920
Name:PRESTON-DOUGHERTY, PAULA (MSN)
Entity type:Individual
Prefix:
First Name:PAULA
Middle Name:
Last Name:PRESTON-DOUGHERTY
Suffix:
Gender:F
Credentials:MSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7000 ATRIUM WAY STE 6
Mailing Address - Street 2:
Mailing Address - City:MOUNT LAUREL
Mailing Address - State:NJ
Mailing Address - Zip Code:08054-3917
Mailing Address - Country:US
Mailing Address - Phone:856-206-4508
Mailing Address - Fax:
Practice Address - Street 1:128 ROUTE 70
Practice Address - Street 2:
Practice Address - City:MEDFORD
Practice Address - State:NJ
Practice Address - Zip Code:08055-2371
Practice Address - Country:US
Practice Address - Phone:609-953-7105
Practice Address - Fax:609-953-7110
Is Sole Proprietor?:No
Enumeration Date:2015-12-09
Last Update Date:2020-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NR15684900163W00000X
NJ26NJ00622100363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse