Provider Demographics
NPI:1871508168
Name:DAVIS, CARRIE LEA (MSN)
Entity Type:Individual
Prefix:MS
First Name:CARRIE
Middle Name:LEA
Last Name:DAVIS
Suffix:
Gender:F
Credentials:MSN
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Mailing Address - Street 1:ROUTE 12 NAVAL HEALTH CARE NEW ENGLAND GROTON
Mailing Address - Street 2:BLDG 449 ATTN PROFESSIONAL AFFAIRS
Mailing Address - City:GROTON
Mailing Address - State:CT
Mailing Address - Zip Code:06349-5600
Mailing Address - Country:US
Mailing Address - Phone:860-694-2377
Mailing Address - Fax:860-694-2590
Practice Address - Street 1:43 SMITH ROAD
Practice Address - Street 2:NAVAL HEALTH CARE NEW ENGLAND
Practice Address - City:NEWPORT
Practice Address - State:RI
Practice Address - Zip Code:02841-1002
Practice Address - Country:US
Practice Address - Phone:860-694-2377
Practice Address - Fax:860-694-3590
Is Sole Proprietor?:No
Enumeration Date:2006-07-29
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
KY4454P363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAD000Medicare UPIN