Healthcare Provider Details

I. General information

NPI: 1548729072
Provider Name (Legal Business Name): ANNE DAVIS RN BSN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/14/2019
Last Update Date: 11/16/2020
Certification Date: 11/16/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

797 FRANKLIN AVE APT 4
BROOKLYN NY
11238-5539
US

IV. Provider business mailing address

797 FRANKLIN AVE APT 4
BROOKLYN NY
11238-5539
US

V. Phone/Fax

Practice location:
  • Phone: 404-345-1095
  • Fax:
Mailing address:
  • Phone: 404-345-1095
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WC0200X
TaxonomyCritical Care Medicine Registered Nurse
License Number692214-1
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number692214
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: