Healthcare Provider Details

I. General information

NPI: 1760202618
Provider Name (Legal Business Name): LAILA DAVIS CRNP- FAMILY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/15/2024
Last Update Date: 04/04/2026
Certification Date: 04/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

442 PALMER TER
WESTMINSTER MD
21158-9400
US

IV. Provider business mailing address

442 PALMER TER
WESTMINSTER MD
21158-9400
US

V. Phone/Fax

Practice location:
  • Phone: 443-821-6853
  • Fax:
Mailing address:
  • Phone: 443-821-6853
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberR238746
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberR238746
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: