Provider Demographics
NPI:1780732479
Name:DAVIDSON, SALLY MILLER (NP)
Entity type:Individual
Prefix:MS
First Name:SALLY
Middle Name:MILLER
Last Name:DAVIDSON
Suffix:
Gender:F
Credentials:NP
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Mailing Address - Street 1:250 WAMPANOAG TRAIL
Mailing Address - Street 2:SUITE 305
Mailing Address - City:RIVERSIDE
Mailing Address - State:RI
Mailing Address - Zip Code:02915
Mailing Address - Country:US
Mailing Address - Phone:401-270-4541
Mailing Address - Fax:401-270-4081
Practice Address - Street 1:250 WAMPANOAG TRAIL
Practice Address - Street 2:SUITE 305
Practice Address - City:RIVERSIDE
Practice Address - State:RI
Practice Address - Zip Code:02915
Practice Address - Country:US
Practice Address - Phone:401-270-4541
Practice Address - Fax:401-270-4081
Is Sole Proprietor?:No
Enumeration Date:2007-01-08
Last Update Date:2019-06-18
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
RIAPRN01050363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
RID18158Medicare UPIN