Provider Demographics
NPI:1477639797
Name:DAVIDSON, ROSEMARY O (APRN-BC)
Entity Type:Individual
Prefix:
First Name:ROSEMARY
Middle Name:O
Last Name:DAVIDSON
Suffix:
Gender:F
Credentials:APRN-BC
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 936
Mailing Address - Street 2:
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23501-0936
Mailing Address - Country:US
Mailing Address - Phone:757-446-7040
Mailing Address - Fax:757-446-7049
Practice Address - Street 1:825 FAIRFAX AVE STE 201
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23507-1914
Practice Address - Country:US
Practice Address - Phone:757-446-7040
Practice Address - Fax:757-446-7049
Is Sole Proprietor?:No
Enumeration Date:2006-10-29
Last Update Date:2019-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024164603363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1477639797OtherMULTIPLAN
VA1477639797Medicaid
VA1477639797OtherCORVEL
VA1477639797OtherUSA MANAGED CARE
VA1477639797OtherTRICARE/CHAMPUS
VA1477639797OtherOPTIMA HEALTH
NC1477639797Medicaid
VA1477639797OtherVIRGINIA PREMIER HEALTH PLAN
VA1477639797Medicaid