Healthcare Provider Details

I. General information

NPI: 1760729065
Provider Name (Legal Business Name): KIMBERLY DIANE DAVIES RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/08/2013
Last Update Date: 01/08/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

607 MAIN STREET
LANDSDALE PA
19446
US

IV. Provider business mailing address

518 S MAIN ST
SELLERSVILLE PA
18960-2518
US

V. Phone/Fax

Practice location:
  • Phone: 215-362-4950
  • Fax:
Mailing address:
  • Phone: 267-640-6054
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN620208
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: