Provider Demographics
NPI:1700952082
Name:DAVIDSON, NATHAN SMITH II (CRNP)
Entity Type:Individual
Prefix:
First Name:NATHAN
Middle Name:SMITH
Last Name:DAVIDSON
Suffix:II
Gender:M
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 PIDGEON HILL DRIVE
Mailing Address - Street 2:SUITE 400
Mailing Address - City:STERLING
Mailing Address - State:VA
Mailing Address - Zip Code:20165
Mailing Address - Country:US
Mailing Address - Phone:703-430-7090
Mailing Address - Fax:703-444-9878
Practice Address - Street 1:2 PIDGEON HILL DRIVE
Practice Address - Street 2:SUITE 400
Practice Address - City:STERLING
Practice Address - State:VA
Practice Address - Zip Code:20165
Practice Address - Country:US
Practice Address - Phone:703-430-7090
Practice Address - Fax:703-444-9878
Is Sole Proprietor?:No
Enumeration Date:2006-11-28
Last Update Date:2007-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0001143524363L00000X
VA0024143524363L00000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
08712M92Medicare ID - Type Unspecified
P46731Medicare UPIN