Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 363LN0005X | Nurse Practitioner - Neonatal (Critical Care) | F350052 | NY |
NPI | 1073636858 |
---|---|
Provider Name | Ms. Judith Ilene Davison |
First Address | Manorville, NY 11949 |
Second Address | Smithtown, NY 11787 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/04/2007 |
Last Update Date | 08/07/2007 |