Healthcare Provider Details

I. General information

NPI: 1871563361
Provider Name (Legal Business Name): BETHANN H DAVIS NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/25/2006
Last Update Date: 10/29/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

759 GRANITE ST SOUTH SHORE HEALTH CENTER
BRAINTREE MA
02184
US

IV. Provider business mailing address

759 GRANITE ST SOUTH SHORE HEALTH CENTER
BRAINTREE MA
02184
US

V. Phone/Fax

Practice location:
  • Phone: 781-848-1950
  • Fax: 781-356-4887
Mailing address:
  • Phone: 781-848-1950
  • Fax: 781-356-4887

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number194673
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: