Healthcare Provider Details

I. General information

NPI: 1013871748
Provider Name (Legal Business Name): JULIE MARIE DAVIES
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/16/2025
Last Update Date: 12/16/2025
Certification Date: 12/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1050 MANTUA PIKE
WENONAH NJ
08090-1141
US

IV. Provider business mailing address

1050 MANTUA PIKE
WENONAH NJ
08090-1141
US

V. Phone/Fax

Practice location:
  • Phone: 856-853-0848
  • Fax:
Mailing address:
  • Phone: 856-853-0848
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License NumberSP033028
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: