Healthcare Provider Details

I. General information

NPI: 1255858718
Provider Name (Legal Business Name): NICOLE DAVY FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/25/2017
Last Update Date: 08/25/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 21ST ST NW FL GROUND
WASHINGTON DC
20052-0028
US

IV. Provider business mailing address

1392A TALBERT CT SE UNIT A
WASHINGTON DC
20020-5205
US

V. Phone/Fax

Practice location:
  • Phone: 202-994-5300
  • Fax:
Mailing address:
  • Phone: 646-528-0161
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN1031107
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: