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General NPI Number Information
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NPI Number | 1649324740
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Entity Type | Individual
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Provider Name | HEIDI L. DAVIS CPNP
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Gender | Female
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Dates
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Enumeration Date | 01/23/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 151 STATE ROUTE 10 E STE 105
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City | SUCCASUNNA
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State | NJ
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Zip | 07876-1452
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Country | US
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Telephone | 973-584-0002
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Fax | 973-584-7107
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Provider Business Mailing Address
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Address Line | 50 HILLCREST AVE
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City | MONTVALE
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State | NJ
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Zip | 07645-2228
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Country | US
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Telephone | 201-505-9155
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Fax | 973-584-7104
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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 | 363LP0200X
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Taxonomy Name | Pediatric Nurse Practitioner
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License Number | 26NJ00065300
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License Number State | NJ
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