Healthcare Provider Details

I. General information

NPI: 1215041785
Provider Name (Legal Business Name): JANIS MARIE DAVIDSON PHD, CFNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/19/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5438 8TH STREET
FORT DIX NJ
08640
US

IV. Provider business mailing address

1586 WILLOW POND DR
YARDLEY PA
19067-5796
US

V. Phone/Fax

Practice location:
  • Phone: 609-562-2999
  • Fax: 609-562-5426
Mailing address:
  • Phone: 215-493-5334
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number26NJ00023000
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberVP001591B
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: