Provider Demographics
NPI:1871599456
Name:DAVIS, ANNA ELIZABETH (FNP-C)
Entity type:Individual
Prefix:
First Name:ANNA
Middle Name:ELIZABETH
Last Name:DAVIS
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 284
Mailing Address - Street 2:
Mailing Address - City:BRATTLEBORO
Mailing Address - State:VT
Mailing Address - Zip Code:05302-0284
Mailing Address - Country:US
Mailing Address - Phone:207-602-3571
Mailing Address - Fax:207-602-3573
Practice Address - Street 1:655 MAIN ST
Practice Address - Street 2:
Practice Address - City:SACO
Practice Address - State:ME
Practice Address - Zip Code:04072-1699
Practice Address - Country:US
Practice Address - Phone:207-602-3571
Practice Address - Fax:207-602-3573
Is Sole Proprietor?:No
Enumeration Date:2005-06-28
Last Update Date:2022-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEAP081255363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME296180099Medicaid
999010412OtherRHC-MEDICAID
ME296180099Medicaid
MEP00971143Medicare PIN
MENP449201Medicare PIN
999010412OtherRHC-MEDICAID
MENP449202Medicare PIN
MENP4492Medicare PIN