Healthcare Provider Details

I. General information

NPI: 1437624442
Provider Name (Legal Business Name): BLISS DAVIS NORVILLE FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/05/2018
Last Update Date: 10/05/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

388 VENTURE DR
SMITHFIELD NC
27577-4775
US

IV. Provider business mailing address

170 DEER POINTE DR
SNOW HILL NC
28580-2093
US

V. Phone/Fax

Practice location:
  • Phone: 919-938-0811
  • Fax:
Mailing address:
  • Phone: 252-503-5819
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberF09181394
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: