Individual
DR. JACQUELINE VIOLET DAVIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
642 MILLER AVE, FREEPORT, NY 11520-6313
(347) 610-6206
Mailing address
642 MILLER AVE, FREEPORT, NY 11520-6313
(347) 610-6206
Taxonomy
Speciality
Code
Description
License number
State
363LG0600X
Gerontology Nurse Practitioner
Primary
582057-1
NY
Other
Enumeration date
03/08/2023
Last updated
03/08/2023
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