Provider Demographics
NPI:1912327867
Name:DAVIS, NANCY ANNE
Entity Type:Individual
Prefix:MS
First Name:NANCY
Middle Name:ANNE
Last Name:DAVIS
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:NANCY
Other - Middle Name:ANNE
Other - Last Name:NOVAK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:907 ARROWHEAD DR S
Mailing Address - Street 2:
Mailing Address - City:GLENVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:12302-3520
Mailing Address - Country:US
Mailing Address - Phone:518-641-2765
Mailing Address - Fax:
Practice Address - Street 1:907 ARROWHEAD DR S
Practice Address - Street 2:
Practice Address - City:GLENVILLE
Practice Address - State:NY
Practice Address - Zip Code:12302-3520
Practice Address - Country:US
Practice Address - Phone:518-641-2765
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-18
Last Update Date:2014-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY360769-1163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse