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General NPI Number Information
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NPI Number | 1295815892
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Entity Type | Individual
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Provider Name | RANDI TERRY DAVIS CRNA
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Gender | Female
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Dates
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Enumeration Date | 10/17/2006
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Last Update Date | 10/17/2024
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Provider Practice Location Address
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Address Line | 200 S ORANGE AVE
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City | LIVINGSTON
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State | NJ
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Zip | 07039-5817
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Country | US
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Telephone | 973-577-4056
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Fax |
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Provider Business Mailing Address
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Address Line | 339 CONSORT DR
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City | BALLWIN
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State | MO
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Zip | 63011-4439
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Country | US
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Telephone | 636-386-9224
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Fax | 636-386-7679
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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 | 367500000X
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Taxonomy Name | Certified Registered Nurse Anesthetist
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License Number | 4704197826
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 367500000X
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Taxonomy Name | Certified Registered Nurse Anesthetist
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License Number | 306445
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License Number State | NY
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Taxonomy #3
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Taxonomy Code | 367500000X
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Taxonomy Name | Certified Registered Nurse Anesthetist
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License Number | 26NJ00306400
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License Number State | NJ
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