Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 363LP0808X | Nurse Practitioner - Psychiatric/Mental Health | 26NJ00046800 | NJ |
N | 363LP0808X | Nurse Practitioner - Psychiatric/Mental Health | 567995 | NY |
Y | 363LP0808X | Nurse Practitioner - Psychiatric/Mental Health | R219600 | MD |
NPI | 1023265238 |
---|---|
Provider Name | Miss Patrice Marie Davis |
First Address | Bethesda, MD 20814-1848 |
Second Address | Bethesda, MD 20814-1848 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/08/2008 |
Last Update Date | 16/11/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
Q60079 | (02) | NY |