Provider Demographics
NPI:1922044155
Name:DAVIS, AMY L (APRN)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:L
Last Name:DAVIS
Suffix:
Gender:F
Credentials:APRN
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Mailing Address - Street 1:849 BOSTON POST RD
Mailing Address - Street 2:STE 300
Mailing Address - City:MILFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06460-3537
Mailing Address - Country:US
Mailing Address - Phone:203-432-0076
Mailing Address - Fax:203-432-7289
Practice Address - Street 1:55 LOCK STREET
Practice Address - Street 2:
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06511
Practice Address - Country:US
Practice Address - Phone:203-432-0076
Practice Address - Fax:203-432-7289
Is Sole Proprietor?:No
Enumeration Date:2006-06-22
Last Update Date:2019-04-13
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CTE58277163W00000X
CT2577363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTQ60572Medicare UPIN