Provider Demographics
NPI:1396929824
Name:NORTON, DAVINA GAIL (RN, PHN)
Entity type:Individual
Prefix:MRS
First Name:DAVINA
Middle Name:GAIL
Last Name:NORTON
Suffix:
Gender:F
Credentials:RN, PHN
Other - Prefix:MISS
Other - First Name:DAVINA
Other - Middle Name:GAIL
Other - Last Name:DAVLIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN, PHN
Mailing Address - Street 1:830 SCENIC DR. BLDNG 3
Mailing Address - Street 2:
Mailing Address - City:MODESTO
Mailing Address - State:CA
Mailing Address - Zip Code:95353-3127
Mailing Address - Country:US
Mailing Address - Phone:209-450-5465
Mailing Address - Fax:209-558-8315
Practice Address - Street 1:830 SCENIC DR. BLDNG 3
Practice Address - Street 2:
Practice Address - City:MODESTO
Practice Address - State:CA
Practice Address - Zip Code:95353-3127
Practice Address - Country:US
Practice Address - Phone:209-450-5465
Practice Address - Fax:209-558-8315
Is Sole Proprietor?:No
Enumeration Date:2007-12-19
Last Update Date:2007-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA687032171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA687032OtherCALIFORNIA BRN