Provider Demographics
NPI:1912212887
Name:DAVIS, KATHERINE MARIE (RN,CNS)
Entity Type:Individual
Prefix:
First Name:KATHERINE
Middle Name:MARIE
Last Name:DAVIS
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Gender:F
Credentials:RN,CNS
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:119 RUSSELL ST
Mailing Address - Street 2:SUITE 30
Mailing Address - City:LITTLETON
Mailing Address - State:MA
Mailing Address - Zip Code:01460-1274
Mailing Address - Country:US
Mailing Address - Phone:978-679-1200
Mailing Address - Fax:978-486-4037
Practice Address - Street 1:119 RUSSELL ST
Practice Address - Street 2:SUITE 30
Practice Address - City:LITTLETON
Practice Address - State:MA
Practice Address - Zip Code:01460-1274
Practice Address - Country:US
Practice Address - Phone:978-679-1200
Practice Address - Fax:978-486-4037
Is Sole Proprietor?:No
Enumeration Date:2010-08-16
Last Update Date:2010-08-16
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MA265336364SP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SP0808XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health