Healthcare Provider Details

I. General information

NPI: 1235318825
Provider Name (Legal Business Name): MARSHA RIAL DAVIS RN MS FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/31/2007
Last Update Date: 10/31/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30 CAMPUS ROAD BARD COLLEGE STUDENT HEALTH SERVICE BARD COLLEGE
ANNANDALE ON HUDSON NY
12504
US

IV. Provider business mailing address

30 CAMPUS ROAD BARD COLLEGE STUDENT HEALTH SERVICE BARD COLLEGE
ANNANDALE ON HUDSON NY
12504
US

V. Phone/Fax

Practice location:
  • Phone: 845-758-7433
  • Fax: 845-758-7437
Mailing address:
  • Phone: 845-758-7433
  • Fax: 845-758-7437

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberF3302611
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: