Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LW0102X | Nurse Practitioner - Women's Health | 201062 | MA |
NPI | 1083660310 |
---|---|
Provider Name | Heather A. Davis |
First Address | Northampton, MA 01060-2018 |
Second Address | Northampton, MA 01060-2018 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/05/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
770858 | CONNECTICARE (01) | MA |
NP2169 | BCBS MA (01) | MA |
S96959 | (02) |