Provider Demographics
NPI:1194068650
Name:DAVISON, NICOLE (PA)
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:
Last Name:DAVISON
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
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Mailing Address - Street 1:710 AVIS DR STE 200
Mailing Address - Street 2:
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48108-9649
Mailing Address - Country:US
Mailing Address - Phone:734-373-7246
Mailing Address - Fax:734-375-6585
Practice Address - Street 1:710 AVIS DR STE 200
Practice Address - Street 2:
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48108-9649
Practice Address - Country:US
Practice Address - Phone:734-373-7246
Practice Address - Fax:734-375-6585
Is Sole Proprietor?:No
Enumeration Date:2013-04-03
Last Update Date:2024-09-27
Deactivation Date:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant