Healthcare Provider Details

I. General information

NPI: 1982795225
Provider Name (Legal Business Name): VILMA M. DAVIS APN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/28/2006
Last Update Date: 09/13/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

NEMOURS PEDIATRICS ST. FRANCIS 7TH & CLAYTON STREET SUITE 400
WILMINGTON DE
19805-3165
US

IV. Provider business mailing address

PO BOX 191 PROVIDER ENROLLMENT DEPT
ROCKLAND DE
19732-0191
US

V. Phone/Fax

Practice location:
  • Phone: 302-421-9700
  • Fax: 302-421-9743
Mailing address:
  • Phone: 302-651-6212
  • Fax: 302-651-4945

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberLJ0000172
License Number StateDE
# 2
Primary TaxonomyN
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License NumberLJ0000172
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: