MEDICARE: VINNETTE DAVIS RN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163W00000X	Registered Nurse	368810	NY

General Provider Information

NPI Number	:	1730524570
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	VINNETTE DAVIS RN

Provider Business Mailing Address
First Line	:	100 DEKRUIF PLACE
Second Line	:	APT 30C
City	:	BRONX
State	:	NY
Zip	:	10475
Country	:	US
Telephone Number	:	646-648-3265
Fax Number	:	718-862-0310

Provider Business Practice Location Address
First Line	:	165 ESPLANADE
Second Line	:
City	:	MOUNT VERNON
State	:	NY
Zip	:	10553-1116
Country	:	US
Telephone Number	:	914-699-4083
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/07/2013
Last Update Date	:	05/07/2013

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