MEDICARE: MARY ELIZABETH DAVIDSON RN

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	364S00000X	Clinical Nurse Specialist	RN 174326	OH

General Provider Information

NPI Number	:	1487809539
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARY ELIZABETH DAVIDSON RN

Provider Business Mailing Address
First Line	:	6326 LAKE FRONT
Second Line	:
City	:	MASON
State	:	OH
Zip	:	45040-7779
Country	:	US
Telephone Number	:	513-492-8107
Fax Number	:

Provider Business Practice Location Address
First Line	:	11500 NORTHLAKE DR
Second Line	:	SUITE 200
City	:	CINCINNATI
State	:	OH
Zip	:	45249-1650
Country	:	US
Telephone Number	:	513-247-4296
Fax Number	:

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

Provider Enumeration Date	:	11/17/2008
Last Update Date	:	02/05/2014

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