Healthcare Provider Details

I. General information

NPI: 1134915846
Provider Name (Legal Business Name): RICQUEE DAVIDSON RN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/18/2025
Last Update Date: 04/18/2025
Certification Date: 03/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12 WATER ST STE 401
WHITE PLAINS NY
10601-1401
US

IV. Provider business mailing address

12 WATER ST STE 401
WHITE PLAINS NY
10601-1401
US

V. Phone/Fax

Practice location:
  • Phone: 914-949-3112
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WM0705X
TaxonomyMedical-Surgical Registered Nurse
License Number970291-01
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code163WI0500X
TaxonomyInfusion Therapy Registered Nurse
License Number970291-01
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: