1821101288 NPI number — MS. NANCY R DAVIS APRN,BC

Table of content: MS. NANCY R DAVIS APRN,BC (NPI 1821101288)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1821101288 NPI number — MS. NANCY R DAVIS APRN,BC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DAVIS
Provider First Name:
NANCY
Provider Middle Name:
R
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
APRN,BC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1821101288
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/23/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
359 N 300 W
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ST GEORGE
Provider Business Mailing Address State Name:
UT
Provider Business Mailing Address Postal Code:
84770-2727
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
435-229-1560
Provider Business Mailing Address Fax Number:
435-487-1555

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
359 N 300 W
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ST GEORGE
Provider Business Practice Location Address State Name:
UT
Provider Business Practice Location Address Postal Code:
84770-2727
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
435-229-1560
Provider Business Practice Location Address Fax Number:
435-487-1555
Provider Enumeration Date:
08/17/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LF0000X , with the licence number:  1908224405 , registered in the state of UT ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: D1779 , issued by the state of ( UT ) . This identifiers is of the category "MEDICAID".