Provider Demographics
NPI:1396939666
Name:DAVIS, VIRGINIA ANN (CNS)
Entity type:Individual
Prefix:MS
First Name:VIRGINIA
Middle Name:ANN
Last Name:DAVIS
Suffix:
Gender:F
Credentials:CNS
Other - Prefix:MRS
Other - First Name:VIRGINIA
Other - Middle Name:ANN
Other - Last Name:SINGLEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:940 BELMONT ST
Mailing Address - Street 2:
Mailing Address - City:BROCKTON
Mailing Address - State:MA
Mailing Address - Zip Code:02301-5596
Mailing Address - Country:US
Mailing Address - Phone:774-826-1267
Mailing Address - Fax:774-826-3157
Practice Address - Street 1:940 BELMONT ST
Practice Address - Street 2:
Practice Address - City:BROCKTON
Practice Address - State:MA
Practice Address - Zip Code:02301-5596
Practice Address - Country:US
Practice Address - Phone:774-826-1267
Practice Address - Fax:826-774-3157
Is Sole Proprietor?:No
Enumeration Date:2007-08-30
Last Update Date:2013-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA160949 PC163WP0809X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0809XNursing Service ProvidersRegistered NursePsychiatric/Mental Health, Adult
Provider Identifiers
StateIdentifier IDID TypeIssuer
MADA NS0545Medicare PIN