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NPI Code Detail

MEDICARE: MARSHA RAE DAVIDSON FNP

MEDICARE: MARSHA RAE DAVIDSON FNP
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
1363LF0000XFamily Nurse PractitionerOR

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 : 1871589457
Entity Type Code : Individual
Provider Name (Legal Business Name) : MARSHA RAE DAVIDSON FNP
Provider Business Mailing Address
First Line : 1508 DIVISION ST
Second Line : STE 15
City : OREGON CITY
State : OR
Zip : 97045-1582
Country : US
Telephone Number : 503-657-5555
Fax Number : 503-657-6502
Provider Business Practice Location Address
First Line : 1508 DIVISION ST
Second Line : STE 15
City : OREGON CITY
State : OR
Zip : 97045-1582
Country : US
Telephone Number : 503-657-5555
Fax Number : 503-657-6502
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/20/2005
Last Update Date : 07/08/2007

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