1932249620 NPI number — MRS. ELIZABETH CATHERINE DAVIS FNP

Table of content: MRS. ELIZABETH CATHERINE DAVIS FNP (NPI 1932249620)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1932249620 NPI number — MRS. ELIZABETH CATHERINE DAVIS FNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DAVIS
Provider First Name:
ELIZABETH
Provider Middle Name:
CATHERINE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
FNP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
HAMBLEY
Provider Other First Name:
ELIZABETH
Provider Other Middle Name:
CATHERINE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1932249620
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/25/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1691 THE ALAMEDA
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SAN JOSE
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
95126-2203
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
408-287-7532
Provider Business Mailing Address Fax Number:
408-287-0405

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
801 S HAM LN
Provider Second Line Business Practice Location Address:
SUITE 5
Provider Business Practice Location Address City Name:
LODI
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95242-7501
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
209-334-2448
Provider Business Practice Location Address Fax Number:
209-333-1029
Provider Enumeration Date:
02/08/2007

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:  NP13338 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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