Provider Demographics
NPI:1508520321
Name:DAVIDSON, STEPHANIE (FNP-BC)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:
Last Name:DAVIDSON
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:815 EUCLID AVE
Mailing Address - Street 2:
Mailing Address - City:TORONTO
Mailing Address - State:OH
Mailing Address - Zip Code:43964-1207
Mailing Address - Country:US
Mailing Address - Phone:740-219-1771
Mailing Address - Fax:
Practice Address - Street 1:651 COLLIERS WAY STE 409A
Practice Address - Street 2:
Practice Address - City:WEIRTON
Practice Address - State:WV
Practice Address - Zip Code:26062-5055
Practice Address - Country:US
Practice Address - Phone:304-723-7127
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-27
Last Update Date:2021-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV111007363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily