Provider Demographics
NPI:1134371453
Name:DAVIDSON, MARCIA ELEISE (LPN)
Entity type:Individual
Prefix:MS
First Name:MARCIA
Middle Name:ELEISE
Last Name:DAVIDSON
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23218 MERRICK BLVD
Mailing Address - Street 2:
Mailing Address - City:LAURELTON
Mailing Address - State:NY
Mailing Address - Zip Code:11413-2115
Mailing Address - Country:US
Mailing Address - Phone:718-528-3432
Mailing Address - Fax:
Practice Address - Street 1:23218 MERRICK BLVD
Practice Address - Street 2:
Practice Address - City:LAURELTON
Practice Address - State:NY
Practice Address - Zip Code:11413-2115
Practice Address - Country:US
Practice Address - Phone:718-528-3432
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-17
Last Update Date:2008-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2556851164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse