Healthcare Provider Details

I. General information

NPI: 1285619353
Provider Name (Legal Business Name): MARIANNE JEANETTE DAVIES APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/13/2005
Last Update Date: 06/26/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 HOWARD AVE YALE PHYSICIANS BUILDING - 2ND FLOOR
NEW HAVEN CT
06519-1369
US

IV. Provider business mailing address

PO BOX 9805 300 GEORGE ST 6TH FLOOR
NEW HAVEN CT
06536-0805
US

V. Phone/Fax

Practice location:
  • Phone: 203-785-4191
  • Fax: 203-737-2617
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364SM0705X
TaxonomyMedical-Surgical Clinical Nurse Specialist
License Number002166
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: