Basic Information
| Provider Information | |||||||||
| NPI: | 1073636858 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | DAVISON | ||||||||
| FirstName: | JUDITH | ||||||||
| MiddleName: | ILENE | ||||||||
| NamePrefix: | MS. | ||||||||
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| Credential: | NNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 38 ASHLEY CIRCLE | ||||||||
| Address2: | |||||||||
| City: | MANORVILLE | ||||||||
| State: | NY | ||||||||
| PostalCode: | 11949 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6318740589 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 50 RT 25A | ||||||||
| Address2: | ST CATHERINE OF SIENA MEDICAL CENTER | ||||||||
| City: | SMITHTOWN | ||||||||
| State: | NY | ||||||||
| PostalCode: | 11787 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6318623250 | ||||||||
| FaxNumber: | 6318623543 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/09/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163W00000X | 201673-1 | NY | X | Nursing Service Providers | Registered Nurse | 363LN0005X | F350052 | NY | X | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Neonatal, Critical Care |
No ID Information.