Provider Demographics
NPI:1699334136
Name:DOHERTY, JAMIE LEE (LPN)
Entity type:Individual
Prefix:
First Name:JAMIE
Middle Name:LEE
Last Name:DOHERTY
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:JAMIE
Other - Middle Name:LEE
Other - Last Name:EURE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPN
Mailing Address - Street 1:130 TRAVIS CT
Mailing Address - Street 2:
Mailing Address - City:WINCHESTER
Mailing Address - State:VA
Mailing Address - Zip Code:22602-4478
Mailing Address - Country:US
Mailing Address - Phone:540-931-7039
Mailing Address - Fax:
Practice Address - Street 1:500 PEGASUS CT
Practice Address - Street 2:
Practice Address - City:WINCHESTER
Practice Address - State:VA
Practice Address - Zip Code:22602-4596
Practice Address - Country:US
Practice Address - Phone:540-313-4196
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-09
Last Update Date:2019-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0002035859164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse