Healthcare Provider Details

I. General information

NPI: 1891785309
Provider Name (Legal Business Name): LINDA DAVIDSON RN-CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/26/2005
Last Update Date: 02/01/2021
Certification Date: 02/01/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 S STANFIELD RD STE. A
TROY OH
45373-2372
US

IV. Provider business mailing address

700 S STANFIELD RD STE. A
TROY OH
45373-2372
US

V. Phone/Fax

Practice location:
  • Phone: 937-339-5355
  • Fax: 937-339-3056
Mailing address:
  • Phone: 937-339-5355
  • Fax: 937-339-3056

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WG0000X
TaxonomyGeneral Practice Registered Nurse
License NumberRN143805
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberRN-143805
License Number StateOH
# 3
Primary TaxonomyY
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License NumberAPRN.CNP.01665
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: