Basic Information
| Provider Information | |||||||||
| NPI: | 1609974070 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | DAVEY | ||||||||
| FirstName: | JENNIFER | ||||||||
| MiddleName: | L. | ||||||||
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| Credential: | PA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 400 BALD HILL RD | ||||||||
| Address2: | |||||||||
| City: | WARWICK | ||||||||
| State: | RI | ||||||||
| PostalCode: | 028861617 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4017374420 | ||||||||
| FaxNumber: | 4017379934 | ||||||||
| Practice Location | |||||||||
| Address1: | 400 BALD HILL RD | ||||||||
| Address2: | |||||||||
| City: | WARWICK | ||||||||
| State: | RI | ||||||||
| PostalCode: | 028861617 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4017374420 | ||||||||
| FaxNumber: | 4017379934 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/20/2006 | ||||||||
| 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 | 207Q00000X | PA00195 | RI | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | PA00195 | 01 | RI | LICENSE | OTHER |