Healthcare Provider Details

I. General information

NPI: 1710114830
Provider Name (Legal Business Name): DONNA DEE DAVIS RN, MSN, PMHCNS, CRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/16/2009
Last Update Date: 10/27/2021
Certification Date: 10/26/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 CONGRESS ST
QUINCY MA
02169-0907
US

IV. Provider business mailing address

15 CAMPBELL PL
CAMP HILL PA
17011-2530
US

V. Phone/Fax

Practice location:
  • Phone: 774-319-1355
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number6345
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code163WP0809X
TaxonomyAdult Psychiatric/Mental Health Registered Nurse
License Number308727L
License Number StatePA
# 3
Primary TaxonomyN
Taxonomy Code364SP0809X
TaxonomyAdult Psychiatric/Mental Health Clinical Nurse Specialist
License Number0366453-01
License Number StatePA
# 4
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberSP016271
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: