Individual provider · Type 1 NPI
Shayne King Dougherty, CRNP
Pediatric Nurse Practitioner · Havertown, PA
NPI number
1154358752
Active
Practice location
32 Greenview Ln
Havertown, PA 19083-4313
Mailing address
3400 Civic Center Blvd.
Philadelphia, PA 19104-4399
Specialties and licenses
| Taxonomy | Code | License |
|---|---|---|
| Pediatric Nurse Practitioner Primary | 363LP0200X | SP007565 (PA) |
Pediatric Nurse Practitioner: Definition to come...
About NPI 1154358752
Shayne King Dougherty, CRNP's National Provider Identifier is 1154358752, issued on Jun 27, 2006. The primary taxonomy on file is Pediatric Nurse Practitioner (363LP0200X), and the practice location is in Havertown, PA. The record was last updated on Jul 8, 2007.