MEDICARE: MS. NICOLE M DAVIA PA-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
1	363AM0700X	Medical Physician Assistant	103540	NC

General Provider Information

NPI Number	:	1598709230
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. NICOLE M DAVIA PA-C

Provider Business Mailing Address
First Line	:	1209 BROWN ST
Second Line	:
City	:	WASHINGTON
State	:	NC
Zip	:	27889-4671
Country	:	US
Telephone Number	:	252-975-4308
Fax Number	:	252-948-4828

Provider Business Practice Location Address
First Line	:	1209 BROWN ST
Second Line	:
City	:	WASHINGTON
State	:	NC
Zip	:	27889-4671
Country	:	US
Telephone Number	:	252-975-4308
Fax Number	:	252-948-4828

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

Provider Enumeration Date	:	06/15/2006
Last Update Date	:	10/01/2010

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