Provider Demographics
NPI:1760571533
Name:DAVIS, ELIZABETH MARGARET (NP)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:MARGARET
Last Name:DAVIS
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:36 BIGELOW STREET
Mailing Address - Street 2:APT #3
Mailing Address - City:QUINCY
Mailing Address - State:MA
Mailing Address - Zip Code:02169-5433
Mailing Address - Country:US
Mailing Address - Phone:617-772-6092
Mailing Address - Fax:
Practice Address - Street 1:59 TOWNSEND ST.
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:09119
Practice Address - Country:US
Practice Address - Phone:617-989-8400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA204558363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0397521Medicaid
MANP1003OtherBLUE CROSS BLUE SHIELD
MA0397521Medicaid
DANP1003Medicare ID - Type Unspecified