Provider Demographics
NPI:1851355606
Name:DAVIS, SANDRA G (CRNA)
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:G
Last Name:DAVIS
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:75 NEWMAN AVENUE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:RUMFORD
Mailing Address - State:RI
Mailing Address - Zip Code:02916-1945
Mailing Address - Country:US
Mailing Address - Phone:401-453-0666
Mailing Address - Fax:401-435-7019
Practice Address - Street 1:593 EDDY STREET
Practice Address - Street 2:DAVOL 129
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02903-4923
Practice Address - Country:US
Practice Address - Phone:401-444-4933
Practice Address - Fax:401-444-5083
Is Sole Proprietor?:No
Enumeration Date:2006-04-17
Last Update Date:2012-07-23
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
VA0024166061367500000X
RIRNA36737367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered