Provider Demographics
NPI:1790444792
Name:DAVIS, CHRISTIAN DENNISE (NP-C)
Entity Type:Individual
Prefix:
First Name:CHRISTIAN
Middle Name:DENNISE
Last Name:DAVIS
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:CHRISTIAN
Other - Middle Name:D
Other - Last Name:PEDROZA ALVAREZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1308 LONGDALE DR APT 102
Mailing Address - Street 2:
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23513-4728
Mailing Address - Country:US
Mailing Address - Phone:757-362-1751
Mailing Address - Fax:
Practice Address - Street 1:1308 LONGDALE DR APT 102
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23513-4728
Practice Address - Country:US
Practice Address - Phone:757-362-1751
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-12-17
Last Update Date:2021-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024183164363L00000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner