Provider Demographics
NPI:1033483540
Name:DAVIS, MARILYN MONICA (RN)
Entity Type:Individual
Prefix:MS
First Name:MARILYN
Middle Name:MONICA
Last Name:DAVIS
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3300 PALMER AVE
Mailing Address - Street 2:APT. 420
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10475-1500
Mailing Address - Country:US
Mailing Address - Phone:718-671-1808
Mailing Address - Fax:
Practice Address - Street 1:1441 OLD NORTHERN BLVD
Practice Address - Street 2:THE BEACON GROUP
Practice Address - City:ROSLYN
Practice Address - State:NY
Practice Address - Zip Code:11576
Practice Address - Country:US
Practice Address - Phone:516-625-6846
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-03-01
Last Update Date:2012-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY507860163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse