Healthcare Provider Details

I. General information

NPI: 1033515531
Provider Name (Legal Business Name): ALISON MILES DAVIDSON FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ALISON ANNE MILES FNP-BC

II. Dates (important events)

Enumeration Date: 11/10/2014
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1190 5TH AVE # GP2W
NEW YORK NY
10029-6503
US

IV. Provider business mailing address

1190 5TH AVE # 1028
NEW YORK NY
10029-6503
US

V. Phone/Fax

Practice location:
  • Phone: 212-659-6800
  • Fax: 212-659-6816
Mailing address:
  • Phone: 212-659-6800
  • Fax: 212-659-6818

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN1020025
License Number StateDC
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number341679
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: