MIRIAM A DAVIDSON


Address: 350 City View Dr Ste 302, Evanston, WY 82930-5307
Phone: 3077897915

MIRIAM A DAVIDSON (NPI# 1932427671) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).

Provider Overview

Nation Provider ID (NPI) 1932427671
Entity Type Individual
Full Name MIRIAM A DAVIDSON
Credential PNP
Practice Address 350 City View Dr Ste 302
Evanston
WY 82930-5307
Mailing Address 1300 N 17th Ave
Greeley
CO 80631-9584
Practice Telephone 3077897915
Practice Fax Number 3077897915
Mailing Telephone 9703472120
Mailing Fax Number 9703469800
Enumeration Date 2010-05-05
Last Update Date 2011-12-07
Gender Code F
Is Sole Proprietor N

Taxonomy

Primary Taxonomy Code Classification License Number License State Taxonomy Group
Y 363LP0808X Nurse Practitioner
Specialization: Psych/Mental Health
25621.1033RX WY Physician Assistants & Advanced Practice Nursing Providers

Other Provider Identifier

State Issuer Identifier Type Code
WY PSYCHIATRIC NURSE PRACTIONNER 25621.1033RX 01

Office Location

Street Address 350 CITY VIEW DR STE 302
City EVANSTON
State WY
Zip Code 82930-5307

Providers in the same location

NPI Name Taxonomy Address Enumeration
1407124373 Shauna M Ottley Case Manager/Care Coordinator 350 City View Dr Ste 302, Evanston, WY 82930-5307 2011-12-07
1508149709 Amy Tennant Community Health Worker 350 City View Dr Ste 302, Evanston, WY 82930-5307 2011-09-23
1578857884 Vicki Vreeland Case Manager/Care Coordinator 350 City View Dr Ste 302, Evanston, WY 82930-5307 2011-06-03

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Taxonomy Information

Taxonomy Code 363LP0808X
Grouping Physician Assistants & Advanced Practice Nursing Providers
Classification Nurse Practitioner
Specialization Psych/Mental Health

Taxonomy Definition

Definition to come...

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1639729056 Sherra Stclair Nurse Practitioner 121 E Grand Ave Ste 204, Laramie, WY 82070-3600 2019-09-17
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Competitor

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City EVANSTON
Zip Code 82930

Improve Information

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Dataset Information

Data Provider Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES)
Jurisdiction Medicare & Medicaid

This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.

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