Provider Demographics
NPI:1316537616
Name:DAVIDSON, RODERIKA NADINE
Entity Type:Individual
Prefix:
First Name:RODERIKA
Middle Name:NADINE
Last Name:DAVIDSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2712 TERRACE RD SE APT B610
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20020-2518
Mailing Address - Country:US
Mailing Address - Phone:540-755-5054
Mailing Address - Fax:
Practice Address - Street 1:1490 7TH ST NW # HODGE804
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20001-3388
Practice Address - Country:US
Practice Address - Phone:202-294-7473
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-20
Last Update Date:2021-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DC3747P1801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant