Provider Demographics
NPI:1750367140
Name:DAVIA, MARY ELAINE (CRNP)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:ELAINE
Last Name:DAVIA
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1515A MARRIOTTSVILLE RD
Mailing Address - Street 2:
Mailing Address - City:MARRIOTTSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21104-1301
Mailing Address - Country:US
Mailing Address - Phone:410-442-2079
Mailing Address - Fax:
Practice Address - Street 1:1515A MARRIOTTSVILLE RD
Practice Address - Street 2:
Practice Address - City:MARRIOTTSVILLE
Practice Address - State:MD
Practice Address - Zip Code:21104-1301
Practice Address - Country:US
Practice Address - Phone:410-442-2079
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-19
Last Update Date:2011-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR043216363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily