Doctor Name: | MRS. SUZETTE DAVENPORT |
NPI Number: | 1366813982 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | NP-C |
License Number: | 26NJ00513600 |
Business Practice Address: | 191 Scenic Lakes Rd Sussex, NJ - 074614004 |
Business Phone Number: | 2015729798 |
Business Fax Number: | |
Mailing Address: | 191 Scenic Lakes Rd, SUSSEX |
State: | NJ |
Postal Code: | 074614004 |
Phone Number: | 2015729798 |
Fax Number: | |
NPI Enumeration Date: | 10/08/2015 |
NPI Last Update Date: | 10/08/2015 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363LA2200X |
License Number: | 26NJ00513600 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | NJ |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Nurse Practitioner |
Taxonomy Specialization: | Adult Health |
Taxonomy Definition: |