Provider Demographics
NPI:1568823334
Name:DAVILA, LIDIA ELIZABETH (CRNP)
Entity Type:Individual
Prefix:
First Name:LIDIA
Middle Name:ELIZABETH
Last Name:DAVILA
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 1:1417 MADISON PARK DR
Mailing Address - Street 2:
Mailing Address - City:GLEN BURNIE
Mailing Address - State:MD
Mailing Address - Zip Code:21061-5613
Mailing Address - Country:US
Mailing Address - Phone:410-768-6600
Mailing Address - Fax:410-768-3132
Practice Address - Street 1:1417 MADISON PARK DR
Practice Address - Street 2:
Practice Address - City:GLEN BURNIE
Practice Address - State:MD
Practice Address - Zip Code:21061-5613
Practice Address - Country:US
Practice Address - Phone:410-768-6600
Practice Address - Fax:410-768-3132
Is Sole Proprietor?:No
Enumeration Date:2016-03-08
Last Update Date:2023-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCRN1019874163W00000X, 363LA2100X
MDR198453364SA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SA2100XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistAcute Care
No163W00000XNursing Service ProvidersRegistered Nurse
No363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care