Provider Demographics
NPI:1629053863
Name:MCCOY-DAVIS, LINDA MARIE (CRNA)
Entity Type:Individual
Prefix:
First Name:LINDA
Middle Name:MARIE
Last Name:MCCOY-DAVIS
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 1:456 HARRISON AVENUE
Mailing Address - Street 2:
Mailing Address - City:GLENSIDE
Mailing Address - State:PA
Mailing Address - Zip Code:19038
Mailing Address - Country:US
Mailing Address - Phone:215-885-0703
Mailing Address - Fax:
Practice Address - Street 1:2701 BLAIR MILL RD
Practice Address - Street 2:SUITE 35
Practice Address - City:WILLOW GROVE
Practice Address - State:PA
Practice Address - Zip Code:19090-1041
Practice Address - Country:US
Practice Address - Phone:215-443-0505
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-09
Last Update Date:2007-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARN507297L367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA075889Medicare ID - Type Unspecified