Provider Demographics
NPI:1912315169
Name:DAVISON, ELIZABETH (PA)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:
Last Name:DAVISON
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:295 E MAIN ST # 315
Mailing Address - Street 2:
Mailing Address - City:DENVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:07834-2642
Mailing Address - Country:US
Mailing Address - Phone:973-370-3130
Mailing Address - Fax:844-922-2777
Practice Address - Street 1:295 E MAIN ST # 315
Practice Address - Street 2:
Practice Address - City:DENVILLE
Practice Address - State:NJ
Practice Address - Zip Code:07834-2642
Practice Address - Country:US
Practice Address - Phone:973-370-3130
Practice Address - Fax:844-922-2777
Is Sole Proprietor?:No
Enumeration Date:2014-07-31
Last Update Date:2023-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MP00342100363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant