Provider Demographics
NPI:1386751956
Name:DAVIS, ROBERT RICHARD (CRNP)
Entity type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:RICHARD
Last Name:DAVIS
Suffix:
Gender:M
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:372 W LANCASTER AVENUE
Mailing Address - Street 2:
Mailing Address - City:WAYNE
Mailing Address - State:PA
Mailing Address - Zip Code:19087-3924
Mailing Address - Country:US
Mailing Address - Phone:610-688-8807
Mailing Address - Fax:610-688-2970
Practice Address - Street 1:372 W LANCASTER AVENUE
Practice Address - Street 2:
Practice Address - City:WAYNE
Practice Address - State:PA
Practice Address - Zip Code:19087
Practice Address - Country:US
Practice Address - Phone:610-688-8807
Practice Address - Fax:610-688-2970
Is Sole Proprietor?:No
Enumeration Date:2006-08-23
Last Update Date:2024-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA003222-L111N00000X
PASP009548363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No111N00000XChiropractic ProvidersChiropractor