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General NPI Number Information
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NPI Number | 1265559009
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Entity Type | Individual
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Provider Name | MS. MARY GWEN DAVENPORT IX
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Gender | Female
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Dates
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Enumeration Date | 03/26/2007
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Last Update Date | 04/20/2008
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Provider Practice Location Address
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Address Line | COMDT CG-1122 US COAST GUARD 2100 2ND ST SW, SUITE 5314
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City | WASHINGTON
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State | DC
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Zip | 20593-0001
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Country | US
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Telephone | 671-355-4885
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Fax | 671-355-4928
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Provider Business Mailing Address
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Address Line | USCGC SEQUOIA WLB 215 VICTOR WHARF PIER THREE
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City | FPO
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State | AP
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Zip | 96678 3922
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Country | US
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Telephone | 671-355-4885
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Fax | 3554928
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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 | 247200000X
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Taxonomy Name | Other Technician
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License Number |
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License Number State |
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