Basic Information
| Provider Information | |||||||||
| NPI: | 1154677334 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | DAVIS | ||||||||
| FirstName: | JOHANNA | ||||||||
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| Credential: | FNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 42 DALLAS HILL RD | ||||||||
| Address2: | |||||||||
| City: | RANGELEY | ||||||||
| State: | ME | ||||||||
| PostalCode: | 049700569 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2078642699 | ||||||||
| FaxNumber: | 2078642969 | ||||||||
| Practice Location | |||||||||
| Address1: | 8 SOUTH MAIN ST | ||||||||
| Address2: | |||||||||
| City: | MADISON | ||||||||
| State: | ME | ||||||||
| PostalCode: | 04950 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2076963992 | ||||||||
| FaxNumber: | 2076963974 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/25/2012 | ||||||||
| LastUpdateDate: | 07/25/2012 | ||||||||
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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 | 363LF0000X | R058417 | ME | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.