Provider Demographics
NPI:1083660310
Name:DAVIS, HEATHER A (RNC, NP)
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:A
Last Name:DAVIS
Suffix:
Gender:F
Credentials:RNC, NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:61 LOCUST ST
Mailing Address - Street 2:#1
Mailing Address - City:NORTHAMPTON
Mailing Address - State:MA
Mailing Address - Zip Code:01060-2018
Mailing Address - Country:US
Mailing Address - Phone:413-584-2303
Mailing Address - Fax:413-586-3212
Practice Address - Street 1:61 LOCUST ST
Practice Address - Street 2:#1
Practice Address - City:NORTHAMPTON
Practice Address - State:MA
Practice Address - Zip Code:01060-2018
Practice Address - Country:US
Practice Address - Phone:413-584-2303
Practice Address - Fax:413-586-3212
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA201062363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA770858OtherCONNECTICARE
MANP2169OtherBCBS MA
NP2169Medicare ID - Type Unspecified
MA770858OtherCONNECTICARE