Provider Demographics
NPI:1942999289
Name:DAVISON, NAN F (LMT)
Entity Type:Individual
Prefix:MRS
First Name:NAN
Middle Name:F
Last Name:DAVISON
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:OLIVIA
Other - Middle Name:
Other - Last Name:DAVISON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LMT
Mailing Address - Street 1:3405 FIDDLERS GRN
Mailing Address - Street 2:
Mailing Address - City:FALLS CHURCH
Mailing Address - State:VA
Mailing Address - Zip Code:22044-1240
Mailing Address - Country:US
Mailing Address - Phone:202-374-1850
Mailing Address - Fax:
Practice Address - Street 1:2250 CLARENDON BLVD STE K
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:VA
Practice Address - Zip Code:22201-3349
Practice Address - Country:US
Practice Address - Phone:202-374-1850
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-03
Last Update Date:2023-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0019008765225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist