Provider Demographics
NPI:1871808014
Name:DAVIS, ANNETTA DELORES (APN,C)
Entity type:Individual
Prefix:MRS
First Name:ANNETTA
Middle Name:DELORES
Last Name:DAVIS
Suffix:
Gender:F
Credentials:APN,C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:73 JENNIFER LN
Mailing Address - Street 2:
Mailing Address - City:BURLINGTON TOWNSHIP
Mailing Address - State:NJ
Mailing Address - Zip Code:08016-1145
Mailing Address - Country:US
Mailing Address - Phone:609-386-1080
Mailing Address - Fax:609-386-1080
Practice Address - Street 1:1401 ROUTE 70 E
Practice Address - Street 2:SUITE #1
Practice Address - City:CHERRY HILL
Practice Address - State:NJ
Practice Address - Zip Code:08034-2207
Practice Address - Country:US
Practice Address - Phone:856-429-7600
Practice Address - Fax:609-429-7130
Is Sole Proprietor?:No
Enumeration Date:2010-08-12
Last Update Date:2013-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ00299600363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health