Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP0808X | Nurse Practitioner - Psychiatric/Mental Health | 077027292N6PMHNPPP | OR |
NPI | 1033379235 |
---|---|
Provider Name | Mrs. Sherry Diane Davidson |
First Address | Beaverton, OR 97005 |
Second Address | Beaverton, OR 97005 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 11/06/2008 |
Last Update Date | 11/06/2008 |