Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LA2100X | Nurse Practitioner - Acute Care | SP018345 | PA |
NPI | 1003321928 |
---|---|
Provider Name | Ms. Nykishia Nicole Davis |
First Address | Philadelphia, PA 19104 |
Second Address | Phila, PA 19150-2507 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/12/2017 |
Last Update Date | 18/12/2020 |