Individual
ELLEN CLARK DAVIES
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
17 E 102ND ST FL 3, NEW YORK, NY 10029
(212) 241-7968
(212) 824-2312
Mailing address
17 E 102ND ST FL 3, NEW YORK, NY 10029-5204
(212) 241-7968
(212) 824-2312
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
623297
NY
363LF0000X
Family Nurse Practitioner
Primary
341606
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
05691387
—
NY
Enumeration date
06/13/2016
Last updated
10/10/2019
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