Basic Information
| Provider Information | |||||||||
| NPI: | 1235413139 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | DAVIS | ||||||||
| FirstName: | AVRILLE | ||||||||
| MiddleName: | Y | ||||||||
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| Credential: | RN, CNS-BC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 501 PONDVIEW LOOP | ||||||||
| Address2: | |||||||||
| City: | WAPPINGERS FALLS | ||||||||
| State: | NY | ||||||||
| PostalCode: | 125907548 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7187928115 | ||||||||
| FaxNumber: | 7183201289 | ||||||||
| Practice Location | |||||||||
| Address1: | 3219 E TREMONT AVE | ||||||||
| Address2: | |||||||||
| City: | BRONX | ||||||||
| State: | NY | ||||||||
| PostalCode: | 104615751 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7187928115 | ||||||||
| FaxNumber: | 7187922652 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/11/2011 | ||||||||
| LastUpdateDate: | 01/07/2018 | ||||||||
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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 | 364SA2200X | CNS3031892 | FL | N | Physician Assistants & Advanced Practice Nursing Providers | Clinical Nurse Specialist | Adult Health | 364SA2200X | A454317-1 | NY | Y | Physician Assistants & Advanced Practice Nursing Providers | Clinical Nurse Specialist | Adult Health |
No ID Information.