Basic Information
| Provider Information | |||||||||
| NPI: | 1689724098 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | DAVIS | ||||||||
| FirstName: | CAROLE | ||||||||
| MiddleName: | P | ||||||||
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| Credential: | NP | ||||||||
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| Mailing Information | |||||||||
| Address1: | LAHEY CLINIC | ||||||||
| Address2: | 41 MALL RD. | ||||||||
| City: | BURLINGTON | ||||||||
| State: | MA | ||||||||
| PostalCode: | 018050001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7817445100 | ||||||||
| FaxNumber: | 7817445743 | ||||||||
| Practice Location | |||||||||
| Address1: | LAHEY CLINIC | ||||||||
| Address2: | 41 MALL RD. | ||||||||
| City: | BURLINGTON | ||||||||
| State: | MA | ||||||||
| PostalCode: | 018050001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7817445100 | ||||||||
| FaxNumber: | 7817445743 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/11/2007 | ||||||||
| LastUpdateDate: | 10/24/2011 | ||||||||
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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 | 363L00000X | 109834 | MA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner |
ID Information
| ID | Type | State | Issuer | Description | 0375870 | 05 | MA | MEDICAID | 110018249A | 05 | MA | MEDICAID |