Provider Demographics
NPI:1093073769
Name:DAVIS, MAXINE MAY (EDD)
Entity Type:Individual
Prefix:
First Name:MAXINE
Middle Name:MAY
Last Name:DAVIS
Suffix:
Gender:F
Credentials:EDD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3050 REGENT BLVD. SUITE 400
Mailing Address - Street 2:EMSI NETWORK DEVELOPMENT
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75063
Mailing Address - Country:US
Mailing Address - Phone:610-841-3418
Mailing Address - Fax:866-757-1482
Practice Address - Street 1:3050 REGENT BLVD SUITE 400
Practice Address - Street 2:EMSI NETWORK DEVELOPMENT
Practice Address - City:IRVING
Practice Address - State:TX
Practice Address - Zip Code:75063
Practice Address - Country:US
Practice Address - Phone:610-841-3418
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-05-01
Last Update Date:2016-07-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NJ26NJ00097000363LG0600X
PASP013730363LG0600X
NYF340960-1363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology