Provider Demographics
NPI:1720556921
Name:DAVIS, JUSTINE L (RN)
Entity Type:Individual
Prefix:
First Name:JUSTINE
Middle Name:L
Last Name:DAVIS
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:JUSTINE
Other - Middle Name:L
Other - Last Name:MAWE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:315 UNIVERSITY AVE
Mailing Address - Street 2:
Mailing Address - City:WESTWOOD
Mailing Address - State:MA
Mailing Address - Zip Code:02090-2315
Mailing Address - Country:US
Mailing Address - Phone:781-375-2250
Mailing Address - Fax:
Practice Address - Street 1:315 UNIVERSITY AVE
Practice Address - Street 2:
Practice Address - City:WESTWOOD
Practice Address - State:MA
Practice Address - Zip Code:02090-2315
Practice Address - Country:US
Practice Address - Phone:781-375-2250
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-06
Last Update Date:2018-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN280366163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse