Basic Information
Provider Information
NPI: 1144311267
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: DAVIES
FirstName: THERESA
MiddleName: J
NamePrefix: MISS
NameSuffix:  
Credential: ARNP
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 41 UNIVERSITY DR STE 300
Address2:  
City: NEWTOWN
State: PA
PostalCode: 189401873
CountryCode: US
TelephoneNumber: 2157105522
FaxNumber: 2157105181
Practice Location
Address1: 4595 NEW FALLS RD STE A
Address2:  
City: LEVITTOWN
State: PA
PostalCode: 190563004
CountryCode: US
TelephoneNumber: 2675873700
FaxNumber: 2159492650
Other Information
ProviderEnumerationDate: 09/27/2006
LastUpdateDate: 05/14/2021
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: Y
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 05/14/2021

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
363LF0000XSP009762PAY Physician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily

No ID Information.


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