Provider Demographics
NPI:1073636858
Name:DAVISON, JUDITH ILENE (NNP)
Entity Type:Individual
Prefix:MS
First Name:JUDITH
Middle Name:ILENE
Last Name:DAVISON
Suffix:
Gender:F
Credentials:NNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:38 ASHLEY CIRCLE
Mailing Address - Street 2:
Mailing Address - City:MANORVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11949
Mailing Address - Country:US
Mailing Address - Phone:631-874-0589
Mailing Address - Fax:
Practice Address - Street 1:50 RT 25A
Practice Address - Street 2:ST CATHERINE OF SIENA MEDICAL CENTER
Practice Address - City:SMITHTOWN
Practice Address - State:NY
Practice Address - Zip Code:11787
Practice Address - Country:US
Practice Address - Phone:631-862-3250
Practice Address - Fax:631-862-3543
Is Sole Proprietor?:No
Enumeration Date:2007-04-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY201673-1163W00000X
NYF350052363LN0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered163W00000XNursing Service ProvidersRegistered Nurse
Not Answered363LN0005XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerNeonatal, Critical Care