Provider Demographics
NPI:1538969225
Name:DOUGHERTY, MINDY (RN)
Entity type:Individual
Prefix:
First Name:MINDY
Middle Name:
Last Name:DOUGHERTY
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1356 NW 16TH CT
Mailing Address - Street 2:
Mailing Address - City:REDMOND
Mailing Address - State:OR
Mailing Address - Zip Code:97756-1477
Mailing Address - Country:US
Mailing Address - Phone:714-420-1208
Mailing Address - Fax:
Practice Address - Street 1:1356 NW 16TH CT
Practice Address - Street 2:
Practice Address - City:REDMOND
Practice Address - State:OR
Practice Address - Zip Code:97756-1477
Practice Address - Country:US
Practice Address - Phone:714-420-1208
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-13
Last Update Date:2025-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR201408333RN163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health