Provider Demographics
NPI:1366745796
Name:DOHERTY, VIRGINIA BOWERS (RN/NP)
Entity type:Individual
Prefix:
First Name:VIRGINIA
Middle Name:BOWERS
Last Name:DOHERTY
Suffix:
Gender:F
Credentials:RN/NP
Other - Prefix:
Other - First Name:VIRGINIA
Other - Middle Name:LEIGH
Other - Last Name:BOWERS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APN-BC
Mailing Address - Street 1:295 VARNUM AVE
Mailing Address - Street 2:
Mailing Address - City:LOWELL
Mailing Address - State:MA
Mailing Address - Zip Code:01854-2134
Mailing Address - Country:US
Mailing Address - Phone:978-942-2064
Mailing Address - Fax:978-942-2068
Practice Address - Street 1:295 VARNUM AVE
Practice Address - Street 2:
Practice Address - City:LOWELL
Practice Address - State:MA
Practice Address - Zip Code:01854-2134
Practice Address - Country:US
Practice Address - Phone:978-942-2064
Practice Address - Fax:978-942-2068
Is Sole Proprietor?:No
Enumeration Date:2010-12-07
Last Update Date:2020-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN285090363L00000X, 363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner