Provider Demographics
NPI:1275513228
Name:DAVIS, CLAIRE MARIE (NP)
Entity Type:Individual
Prefix:
First Name:CLAIRE
Middle Name:MARIE
Last Name:DAVIS
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 751803
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28275-1803
Mailing Address - Country:US
Mailing Address - Phone:336-722-1818
Mailing Address - Fax:336-722-1826
Practice Address - Street 1:2001 TODAYS WOMAN AVE
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27105-5069
Practice Address - Country:US
Practice Address - Phone:336-722-1818
Practice Address - Fax:336-722-1826
Is Sole Proprietor?:No
Enumeration Date:2006-01-18
Last Update Date:2013-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC0009-40005363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7000955Medicaid
NCP84478Medicare UPIN
NC2802598Medicare PIN