Provider Demographics
NPI:1932421575
Name:DAVIDSON, MARYANNE (DNSC, APRN, CPNP)
Entity type:Individual
Prefix:DR
First Name:MARYANNE
Middle Name:
Last Name:DAVIDSON
Suffix:
Gender:F
Credentials:DNSC, APRN, CPNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1151 HARTFORD TPKE
Mailing Address - Street 2:QUINNIPIACK VALLEY HEALTH DISTRICT
Mailing Address - City:NORTH HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06473-3041
Mailing Address - Country:US
Mailing Address - Phone:203-248-4528
Mailing Address - Fax:203-248-6671
Practice Address - Street 1:1151 HARTFORD TPKE
Practice Address - Street 2:QUINNIPIACK VALLEY HEALTH DISTRICT
Practice Address - City:NORTH HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06473-3041
Practice Address - Country:US
Practice Address - Phone:203-248-4528
Practice Address - Fax:203-248-6671
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-24
Last Update Date:2010-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT002145363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics