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General NPI Number Information
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NPI Number | 1023732021
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Entity Type | Individual
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Provider Name | NEDRA TENLEY DAVIDSON
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Gender | Female
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Dates
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Enumeration Date | 10/03/2022
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Last Update Date | 10/03/2022
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Provider Practice Location Address
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Address Line | 1206 FORREST AVE
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City | DOVER
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State | DE
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Zip | 19904-3311
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Country | US
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Telephone | 877-286-5115
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Fax |
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Provider Business Mailing Address
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Address Line | 1778 PEACHTREE RUN
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City | MAGNOLIA
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State | DE
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Zip | 19962-1805
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Country | US
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Telephone | 302-212-9009
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 163WA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Registered Nurse
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License Number | L1-0043224
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License Number State | DE
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