Individual
COLLEEN DAVIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
P.A.
Contact information
Practice address
1306 N BROOM ST, WILMINGTON, DE 19806-4209
(302) 571-9750
(302) 571-0620
Mailing address
1306 N BROOM ST, WILMINGTON, DE 19806-4209
(302) 571-9750
(302) 571-0620
Taxonomy
Speciality
Code
Description
License number
State
363AS0400X
Surgical Physician Assistant
C03083
MD
363AS0400X
Surgical Physician Assistant
Primary
C50000438
DE
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
016022N04
RAILROAD MEDICARE
DE
01
—
C03083
MD STATE LICENSE
MD
01
—
C50000438
DE LICENSE
DE
Enumeration date
09/26/2006
Last updated
08/06/2008
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