Provider Demographics
NPI:1134145089
Name:DAVIS, EILEEN TERESE (RN, APN, C)
Entity type:Individual
Prefix:MRS
First Name:EILEEN
Middle Name:TERESE
Last Name:DAVIS
Suffix:
Gender:F
Credentials:RN, APN, C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29 RAYMOND AVE
Mailing Address - Street 2:
Mailing Address - City:RUTHERFORD
Mailing Address - State:NJ
Mailing Address - Zip Code:07070-1131
Mailing Address - Country:US
Mailing Address - Phone:201-896-8278
Mailing Address - Fax:201-896-6024
Practice Address - Street 1:718 TEANECK RD
Practice Address - Street 2:HOLY NAME HOSPITAL CLINIC
Practice Address - City:TEANECK
Practice Address - State:NJ
Practice Address - Zip Code:07666-4245
Practice Address - Country:US
Practice Address - Phone:201-833-3174
Practice Address - Fax:201-833-7248
Is Sole Proprietor?:No
Enumeration Date:2006-07-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NN10250000363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJS94977Medicare UPIN