Healthcare Provider Details

I. General information

NPI: 1003341793
Provider Name (Legal Business Name): TONI MONIQUE DAVIDSON RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/01/2017
Last Update Date: 05/01/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6900 ALDEN DR
CHEYENNE WY
82005-3906
US

IV. Provider business mailing address

66 FORT WARREN AVE UNIT A
CHEYENNE WY
82001-8280
US

V. Phone/Fax

Practice location:
  • Phone: 307-773-5084
  • Fax: 307-773-6660
Mailing address:
  • Phone: 732-904-5079
  • Fax: 307-773-6660

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP2201X
TaxonomyAmbulatory Care Registered Nurse
License Number26NR10982900
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: