Provider Demographics
NPI:1154483428
Name:DAVIE, JOALIE EMMANUELLE (MD)
Entity Type:Individual
Prefix:DR
First Name:JOALIE EMMANUELLE
Middle Name:
Last Name:DAVIE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:932 CAMINO DON EMILIO
Mailing Address - Street 2:
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87507-7684
Mailing Address - Country:US
Mailing Address - Phone:505-819-9717
Mailing Address - Fax:
Practice Address - Street 1:932 CAMINO DON EMILIO
Practice Address - Street 2:
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87507-7684
Practice Address - Country:US
Practice Address - Phone:505-819-9717
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-14
Last Update Date:2010-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA52411207R00000X
174H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No174H00000XOther Service ProvidersHealth Educator