Provider Demographics
NPI:1447388921
Name:DAVIS-MITREA, JODY (CRNA)
Entity Type:Individual
Prefix:
First Name:JODY
Middle Name:
Last Name:DAVIS-MITREA
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:622 W 168TH ST
Mailing Address - Street 2:NEW YORK PRESBYTERIAN HOSPITAL, DEPT. OF ANESTHESIOLOGY
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10032-3720
Mailing Address - Country:US
Mailing Address - Phone:212-305-9876
Mailing Address - Fax:914-709-8165
Practice Address - Street 1:622 W 168TH ST
Practice Address - Street 2:NEW YORK PRESBYTERIAN HOSPITAL, DEPT. OF ANESTHESIOLOGY
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10032-3720
Practice Address - Country:US
Practice Address - Phone:212-305-9876
Practice Address - Fax:914-709-8165
Is Sole Proprietor?:No
Enumeration Date:2007-02-28
Last Update Date:2023-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY398303163W00000X, 367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163W00000XNursing Service ProvidersRegistered Nurse