Provider Demographics
NPI:1912027384
Name:DAVIS, LOUISE L (APRN BC)
Entity Type:Individual
Prefix:MS
First Name:LOUISE
Middle Name:L
Last Name:DAVIS
Suffix:
Gender:F
Credentials:APRN BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:121 MIDDLE STREET
Mailing Address - Street 2:SUITE 404
Mailing Address - City:PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04101-4156
Mailing Address - Country:US
Mailing Address - Phone:207-772-8634
Mailing Address - Fax:
Practice Address - Street 1:121 MIDDLE STREET
Practice Address - Street 2:SUITE 404
Practice Address - City:PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04101-4156
Practice Address - Country:US
Practice Address - Phone:207-772-8634
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MER017880364S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364S00000XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
006502OtherANTHEM BCBS