Healthcare Provider Details

I. General information

NPI: 1700284551
Provider Name (Legal Business Name): GERRIN DAVIS NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/10/2014
Last Update Date: 12/10/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1515 W NORTH AVE STD CLINIC
BALTIMORE MD
21217-1735
US

IV. Provider business mailing address

8410 UPPER SKY WAY APT. 231
LAUREL MD
20723-5625
US

V. Phone/Fax

Practice location:
  • Phone: 410-396-0176
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberR214116
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: