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NPI Code Detail

MEDICARE: MS. MARY ANN DAVIDSON FNP-C

MEDICARE: MS. MARY ANN DAVIDSON FNP-C
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363L00000XNurse Practitioner9448019FL
2363LF0000XFamily Nurse Practitioner71002633AIN

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1114193786
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. MARY ANN DAVIDSON FNP-C
Provider Business Mailing Address
First Line : 7045 W ILLIANA DR
Second Line :
City : WEST TERRE HAUTE
State : IN
Zip : 47885-9006
Country : US
Telephone Number : 812-240-5108
Fax Number :
Provider Business Practice Location Address
First Line : 390 N COURTENAY PKWY
Second Line :
City : MERRITT ISLAND
State : FL
Zip : 32953-3456
Country : US
Telephone Number : 321-633-3162
Fax Number : 321-684-7872
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/05/2008
Last Update Date : 06/04/2019

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