1164794624 NPI number — REBECCA ANN DAVIDSON F.N.P.

Table of content: REBECCA ANN DAVIDSON F.N.P. (NPI 1164794624)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1164794624 NPI number — REBECCA ANN DAVIDSON F.N.P.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DAVIDSON
Provider First Name:
REBECCA
Provider Middle Name:
ANN
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
F.N.P.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
FLYNN
Provider Other First Name:
REBECCA
Provider Other Middle Name:
ANN
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
F.N.P.
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1164794624
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/08/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
30 PLEASANT CIR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CANTON
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
02021-2637
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1400 VFW PKWY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WEST ROXBURY
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
02132-4927
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
857-203-6004
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/30/2012

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LF0000X , with the licence number:  RN278272 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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