Provider Demographics
NPI:1265559009
Name:DAVENPORT, MARY GWEN IX
Entity type:Individual
Prefix:MS
First Name:MARY
Middle Name:GWEN
Last Name:DAVENPORT
Suffix:IX
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:USCGC SEQUOIA WLB 215
Mailing Address - Street 2:VICTOR WHARF PIER THREE
Mailing Address - City:FPO
Mailing Address - State:AP
Mailing Address - Zip Code:96678 3922
Mailing Address - Country:US
Mailing Address - Phone:671-355-4885
Mailing Address - Fax:355-4928
Practice Address - Street 1:COMDT CG-1122 US COAST GUARD
Practice Address - Street 2:2100 2ND ST SW, SUITE 5314
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20593-0001
Practice Address - Country:US
Practice Address - Phone:671-355-4885
Practice Address - Fax:671-355-4928
Is Sole Proprietor?:No
Enumeration Date:2007-03-26
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other