Healthcare Provider Details

I. General information

NPI: 1265483283
Provider Name (Legal Business Name): CHRISTOPHER BARTLETT DAVIS CRNP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/15/2006
Last Update Date: 12/10/2024
Certification Date: 12/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1340 S DIVISION ST STE 301
SALISBURY MD
21804-7095
US

IV. Provider business mailing address

PO BOX 1978
SALISBURY MD
21802-1978
US

V. Phone/Fax

Practice location:
  • Phone: 410-543-2060
  • Fax: 410-543-2051
Mailing address:
  • Phone: 410-749-1015
  • Fax: 410-749-0654

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberR126106
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: