Healthcare Provider Details

I. General information

NPI: 1356755276
Provider Name (Legal Business Name): ANITA RENEE DAVIDSON COE FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/18/2014
Last Update Date: 09/29/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1389 DANTE ROAD
ST. PAUL VA
24283-3658
US

IV. Provider business mailing address

PO BOX 2377 495 EAST MAIN STREET
LEBANON VA
24266-2377
US

V. Phone/Fax

Practice location:
  • Phone: 276-762-0770
  • Fax: 276-546-9711
Mailing address:
  • Phone: 276-889-3700
  • Fax: 276-889-5505

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number00241717177
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: