Provider Demographics
NPI:1316383466
Name:DAVALOS, CLAIRE BRADLEY (RN)
Entity Type:Individual
Prefix:MRS
First Name:CLAIRE
Middle Name:BRADLEY
Last Name:DAVALOS
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3212 BRUNSWICK AVE
Mailing Address - Street 2:
Mailing Address - City:DREXEL HILL
Mailing Address - State:PA
Mailing Address - Zip Code:19026-2108
Mailing Address - Country:US
Mailing Address - Phone:484-574-3985
Mailing Address - Fax:
Practice Address - Street 1:3212 BRUNSWICK AVE
Practice Address - Street 2:
Practice Address - City:DREXEL HILL
Practice Address - State:PA
Practice Address - Zip Code:19026-2108
Practice Address - Country:US
Practice Address - Phone:484-574-3985
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-05-16
Last Update Date:2013-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARN308978L163WX0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WX0200XNursing Service ProvidersRegistered NurseOncology