Provider Demographics
NPI:1003105073
Name:DAVIDSON, LAURA (NP)
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:
Last Name:DAVIDSON
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:65 VILLAGE SQUARE DR STE 302
Mailing Address - Street 2:
Mailing Address - City:SOUTH KINGSTOWN
Mailing Address - State:RI
Mailing Address - Zip Code:02879-2569
Mailing Address - Country:US
Mailing Address - Phone:401-785-0040
Mailing Address - Fax:401-633-6253
Practice Address - Street 1:65 VILLAGE SQUARE DR STE 302
Practice Address - Street 2:
Practice Address - City:SOUTH KINGSTOWN
Practice Address - State:RI
Practice Address - Zip Code:02879-2569
Practice Address - Country:US
Practice Address - Phone:401-785-0040
Practice Address - Fax:401-633-6253
Is Sole Proprietor?:No
Enumeration Date:2011-03-30
Last Update Date:2024-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIAPRN02027363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health