Provider Demographics
NPI:1154677334
Name:DAVIS, JOHANNA (FNP)
Entity Type:Individual
Prefix:
First Name:JOHANNA
Middle Name:
Last Name:DAVIS
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:42 DALLAS HILL RD
Mailing Address - Street 2:
Mailing Address - City:RANGELEY
Mailing Address - State:ME
Mailing Address - Zip Code:04970-0569
Mailing Address - Country:US
Mailing Address - Phone:207-864-2699
Mailing Address - Fax:207-864-2969
Practice Address - Street 1:8 SOUTH MAIN ST
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:ME
Practice Address - Zip Code:04950
Practice Address - Country:US
Practice Address - Phone:207-696-3992
Practice Address - Fax:207-696-3974
Is Sole Proprietor?:No
Enumeration Date:2012-07-25
Last Update Date:2012-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MER058417363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily