MEDICARE: MARY E. DAVIS NP

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
1	363LP2300X	Primary Care Nurse Practitioner	0024107203	VA

General Provider Information

NPI Number	:	1245210079
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARY E. DAVIS NP

Provider Business Mailing Address
First Line	:	5226 NOTTINGHILL LN
Second Line	:
City	:	FAIRFAX
State	:	VA
Zip	:	22032-2622
Country	:	US
Telephone Number	:	703-426-9393
Fax Number	:

Provider Business Practice Location Address
First Line	:	4400 UNIVERSITY DR
Second Line	:	MS 2D3
City	:	FAIRFAX
State	:	VA
Zip	:	22030-4422
Country	:	US
Telephone Number	:	703-993-2842
Fax Number	:	703-993-4365

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/18/2006
Last Update Date	:	07/08/2007

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