Provider Demographics
NPI:1376078055
Name:DAVIS, ARIELLE
Entity Type:Individual
Prefix:
First Name:ARIELLE
Middle Name:
Last Name:DAVIS
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 1:1590 MADISON AVE APT 3H
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10029-3869
Mailing Address - Country:US
Mailing Address - Phone:718-406-6198
Mailing Address - Fax:
Practice Address - Street 1:773 CONCOURSE VLG E
Practice Address - Street 2:APT 16E
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10451-3903
Practice Address - Country:US
Practice Address - Phone:718-406-6198
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-05-01
Last Update Date:2018-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY332248164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse