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General NPI Number Information
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NPI Number | 1063813178
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Entity Type | Individual
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Provider Name | DEBORAH DAVIDSON MSN, APN
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Gender | Female
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Dates
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Enumeration Date | 09/08/2014
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 405 FAIRGROUNDS RD
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City | TIPTON
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State | IN
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Zip | 46072-9596
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Country | US
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Telephone | 765-408-0536
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Fax | 765-405-0539
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Provider Business Mailing Address
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Address Line | 800 FULTON ST
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City | LOGANSPORT
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State | IN
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Zip | 46947-1577
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Country | US
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Telephone | 574-205-2600
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 309.007493
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 71007149A
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License Number State | IN
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