Provider Demographics
NPI:1487649232
Name:DAVIS, DEBORAH ANNE (CRNP)
Entity Type:Individual
Prefix:
First Name:DEBORAH
Middle Name:ANNE
Last Name:DAVIS
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 HOSPITAL RD STE 203
Mailing Address - Street 2:
Mailing Address - City:PRINCE FREDERICK
Mailing Address - State:MD
Mailing Address - Zip Code:20678-4045
Mailing Address - Country:US
Mailing Address - Phone:104-414-4740
Mailing Address - Fax:410-414-4741
Practice Address - Street 1:110 HOSPITAL RD STE 203
Practice Address - Street 2:
Practice Address - City:PRINCE FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:20678-4045
Practice Address - Country:US
Practice Address - Phone:410-414-4740
Practice Address - Fax:410-414-4741
Is Sole Proprietor?:No
Enumeration Date:2005-09-19
Last Update Date:2021-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR108942363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health