Provider Demographics
NPI:1063471530
Name:DAVISON, NANCY (LAC, PT)
Entity Type:Individual
Prefix:
First Name:NANCY
Middle Name:
Last Name:DAVISON
Suffix:
Gender:F
Credentials:LAC, PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5708 FINSBURY CT
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27609-3955
Mailing Address - Country:US
Mailing Address - Phone:919-215-0204
Mailing Address - Fax:919-322-2139
Practice Address - Street 1:5708 FINSBURY CT
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27609-3955
Practice Address - Country:US
Practice Address - Phone:919-215-0204
Practice Address - Fax:919-322-2139
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-22
Last Update Date:2024-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC000321225100000X
NC164171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC20WLEMedicaid
NC20WLEOtherBCBS
NC650022723OtherRAILROAD
NC11914671OtherCAQH
NC562132986OtherCHAMPUS
NC0794AOtherBCBS
NC562132986OtherCHAMPUS