Healthcare Provider Details

I. General information

NPI: 1316383466
Provider Name (Legal Business Name): CLAIRE BRADLEY DAVALOS RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/16/2013
Last Update Date: 05/16/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3212 BRUNSWICK AVE
DREXEL HILL PA
19026-2108
US

IV. Provider business mailing address

3212 BRUNSWICK AVE
DREXEL HILL PA
19026-2108
US

V. Phone/Fax

Practice location:
  • Phone: 484-574-3985
  • Fax:
Mailing address:
  • Phone: 484-574-3985
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WX0200X
TaxonomyOncology Registered Nurse
License NumberRN308978L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: