Healthcare Provider Details

I. General information

NPI: 1497416051
Provider Name (Legal Business Name): ELISABETH J DAVIS APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: ELISABETH B JEFFCOTE

II. Dates (important events)

Enumeration Date: 01/06/2022
Last Update Date: 09/30/2024
Certification Date: 09/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 MEMBERS WAY 5TH FLOOR
DOVER NH
03820-5933
US

IV. Provider business mailing address

PO BOX 412503
BOSTON MA
02241-2503
US

V. Phone/Fax

Practice location:
  • Phone: 603-609-6800
  • Fax: 603-609-6820
Mailing address:
  • Phone: 617-726-3884
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number075886-23
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: