Provider Demographics
NPI:1730368556
Name:DOUGHERTY, RACHEL A (CNP)
Entity type:Individual
Prefix:
First Name:RACHEL
Middle Name:A
Last Name:DOUGHERTY
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:RACHEL
Other - Middle Name:A
Other - Last Name:ZENNER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ARNP
Mailing Address - Street 1:200 HAWKINS DR
Mailing Address - Street 2:
Mailing Address - City:IOWA CITY
Mailing Address - State:IA
Mailing Address - Zip Code:52242-1009
Mailing Address - Country:US
Mailing Address - Phone:319-356-2296
Mailing Address - Fax:319-356-4855
Practice Address - Street 1:200 HAWKINS DR
Practice Address - Street 2:
Practice Address - City:IOWA CITY
Practice Address - State:IA
Practice Address - Zip Code:52242-1009
Practice Address - Country:US
Practice Address - Phone:319-356-2296
Practice Address - Fax:319-356-4855
Is Sole Proprietor?:No
Enumeration Date:2007-10-29
Last Update Date:2008-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAC110981363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA71366OtherWELLMARK BCBS
IA71366OtherWELLMARK BCBS