Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 102L00000X | Psychologist | 643 | NE |
Y | 103T00000X | Psychologist | 643 | NE |
N | 103TC2200X | Clinical Child & Adolescent Psychologist | 643 | NE |
NPI | 1003924150 |
---|---|
Provider Name | Dr. Corrie A Davies |
First Address | Lincoln, NE 68505-3092 |
Second Address | Lincoln, NE 68505-3092 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/08/2006 |
Last Update Date | 10/05/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
470790491 | TAX I.D. (01) | NE |