Healthcare Provider Details

I. General information

NPI: 1467716845
Provider Name (Legal Business Name): KRISTA DAVISON AU.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/29/2012
Last Update Date: 01/24/2020
Certification Date: 01/24/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2 INDUSTRIAL PARK DR
CONCORD NH
03301-8520
US

IV. Provider business mailing address

2 INDUSTRIAL PARK DR
CONCORD NH
03301-8520
US

V. Phone/Fax

Practice location:
  • Phone: 603-224-9043
  • Fax: 603-228-2133
Mailing address:
  • Phone: 603-224-9043
  • Fax: 603-228-2133

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License NumberIA612
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: