Provider Demographics
NPI:1962554287
Name:DAVIS, ROSE-MARIE P (RN)
Entity type:Individual
Prefix:
First Name:ROSE-MARIE
Middle Name:P
Last Name:DAVIS
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:502 EMERSON AVE
Mailing Address - Street 2:
Mailing Address - City:LAURELDALE
Mailing Address - State:PA
Mailing Address - Zip Code:19605-2512
Mailing Address - Country:US
Mailing Address - Phone:610-929-2599
Mailing Address - Fax:610-376-6944
Practice Address - Street 1:230 N 5TH ST
Practice Address - Street 2:3RD FLOOR
Practice Address - City:READING
Practice Address - State:PA
Practice Address - Zip Code:19601-3309
Practice Address - Country:US
Practice Address - Phone:610-376-6077
Practice Address - Fax:610-376-6944
Is Sole Proprietor?:No
Enumeration Date:2007-01-17
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARN543978163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1016133770001Medicaid