Provider Demographics
NPI:1619210200
Name:DAVIS-ROYSTER, VONETTA ALETHIA (CRNP)
Entity Type:Individual
Prefix:
First Name:VONETTA
Middle Name:ALETHIA
Last Name:DAVIS-ROYSTER
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 1:4023 BIDDISON LN
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21206-4144
Mailing Address - Country:US
Mailing Address - Phone:410-357-6735
Mailing Address - Fax:410-824-1171
Practice Address - Street 1:1501 SULGRAVE AVE STE 200
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21209-3650
Practice Address - Country:US
Practice Address - Phone:443-708-5856
Practice Address - Fax:667-212-5095
Is Sole Proprietor?:No
Enumeration Date:2013-04-01
Last Update Date:2022-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR149811363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health