Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP0808X | Nurse Practitioner - Psychiatric/Mental Health | APRN02027 | RI |
NPI | 1003105073 |
---|---|
Provider Name | Laura Davidson |
First Address | Wakefield, RI 02879-3214 |
Second Address | Wakefield, RI 02879-3214 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/03/2011 |
Last Update Date | 04/04/2019 |