Provider Demographics
NPI:1235243163
Name:DAVIDSON, KAREN E (CNM)
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:E
Last Name:DAVIDSON
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:103 NEWTOWN ROAD
Mailing Address - Street 2:CANDLEWOOD CENTER FOR WOMEN'S HEALTH
Mailing Address - City:DANBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06810
Mailing Address - Country:US
Mailing Address - Phone:203-730-8789
Mailing Address - Fax:203-843-5229
Practice Address - Street 1:108 NEWTOWN ROAD
Practice Address - Street 2:CANDLEWOOD CENTER FOR WOMEN'S HEALTH
Practice Address - City:DANBURY
Practice Address - State:CT
Practice Address - Zip Code:06810
Practice Address - Country:US
Practice Address - Phone:203-730-8789
Practice Address - Fax:203-843-5229
Is Sole Proprietor?:No
Enumeration Date:2006-08-18
Last Update Date:2012-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000010367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT004146941Medicaid
NPP000Medicare UPIN
CT004146941Medicaid