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NPI Code Detail

MEDICARE: MS. YVONNE LORELLE DAVIS NURSE PRACTITIONER I

MEDICARE: MS. YVONNE LORELLE DAVIS NURSE PRACTITIONER I
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
1163WP0808XPsychiatric/Mental Health Registered Nurse653726-1NY
2363LP0808XPsychiatric/Mental Health Nurse Practitioner402154NY

General Provider Information

NPI Number : 1942730023
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. YVONNE LORELLE DAVIS NURSE PRACTITIONER I
Provider Business Mailing Address
First Line : 482 BLACK RIVER PKWY
Second Line :
City : WATERTOWN
State : NY
Zip : 13601-2416
Country : US
Telephone Number : 315-782-1777
Fax Number : 315-785-8628
Provider Business Practice Location Address
First Line : 482 BLACK RIVER PKWY
Second Line :
City : WATERTOWN
State : NY
Zip : 13601-2416
Country : US
Telephone Number : 315-782-1777
Fax Number : 315-785-8628
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/12/2017
Last Update Date : 03/17/2018

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Directions to “ MS. YVONNE LORELLE DAVIS NURSE PRACTITIONER I” Practice Location

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