Provider Demographics
NPI:1568453439
Name:DAVIDSON, VIVA (CRNA)
Entity Type:Individual
Prefix:MRS
First Name:VIVA
Middle Name:
Last Name:DAVIDSON
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 1:24 S 18TH ST
Mailing Address - Street 2:
Mailing Address - City:ALLENTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18104-5622
Mailing Address - Country:US
Mailing Address - Phone:610-628-8372
Mailing Address - Fax:610-628-8648
Practice Address - Street 1:1736 W HAMILTON ST
Practice Address - Street 2:
Practice Address - City:ALLENTOWN
Practice Address - State:PA
Practice Address - Zip Code:18104-5656
Practice Address - Country:US
Practice Address - Phone:610-628-8372
Practice Address - Fax:610-628-8648
Is Sole Proprietor?:No
Enumeration Date:2005-10-31
Last Update Date:2007-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARN 227803L367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA011525KDMMedicare ID - Type Unspecified