| Doctor Name: | MRS. DIANNE AMOS DOHERTY |
| NPI Number: | 1821091976 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | N.P. |
| License Number: | 0017000343 |
| Business Practice Address: | 75 Stamp Act Dr Building H Bolivia, NC - 284228320 |
| Business Phone Number: | 9102535788 |
| Business Fax Number: | 9102535968 |
| Mailing Address: | 75 Stamp Act Dr, Building H BOLIVIA |
| State: | NC |
| Postal Code: | 284228320 |
| Phone Number: | 9102535788 |
| Fax Number: | 9102535788 |
| NPI Enumeration Date: | 05/23/2005 |
| NPI Last Update Date: | 07/10/2012 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LA2200X |
| License Number: | 0017000343 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | VA |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Adult Health |
| Taxonomy Definition: | |