Individual
MRS. NICOLE DAVIDSON
Active
Individual
MRS. NICOLE DAVIDSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Taxonomy
Speciality
Code
Description
License number
State
363LA2200X
Adult Health Nurse Practitioner
Primary
267264
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
042297845
TRICARE
—
01
—
042298845
MULTI-PLAN
—
01
—
1801072616
FALLON HEALTH CARE
—
05
—
1801072616
—
MA
01
—
NP7681
BCBSMA
MA
Enumeration date
01/11/2008
Last updated
02/24/2016
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