Healthcare Provider Details

I. General information

NPI: 1023811593
Provider Name (Legal Business Name): DANTE TURRELL DAVIS JR. FNP-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: DANTE TURRELL CHAMPION FNP-C

II. Dates (important events)

Enumeration Date: 03/31/2025
Last Update Date: 04/14/2025
Certification Date: 04/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

125 INDIAN ROCK RD
WINDHAM NH
03087-2009
US

IV. Provider business mailing address

360 US HIGHWAY 1 BYP UNIT 102
PORTSMOUTH NH
03801-7105
US

V. Phone/Fax

Practice location:
  • Phone: 603-890-6330
  • Fax:
Mailing address:
  • Phone: 603-410-6700
  • Fax: 603-319-1308

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WE0003X
TaxonomyEmergency Registered Nurse
License NumberRN2380479
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: