Provider Demographics
NPI:1013567577
Name:DAVIS, RACHAEL MARIE (NP-C)
Entity Type:Individual
Prefix:
First Name:RACHAEL
Middle Name:MARIE
Last Name:DAVIS
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2552 TREELINE DR
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:NC
Mailing Address - Zip Code:28027-2814
Mailing Address - Country:US
Mailing Address - Phone:703-380-4808
Mailing Address - Fax:
Practice Address - Street 1:3821 FORRESTGATE DR
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27103-2930
Practice Address - Country:US
Practice Address - Phone:336-448-9100
Practice Address - Fax:336-448-5282
Is Sole Proprietor?:No
Enumeration Date:2019-09-17
Last Update Date:2019-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC178881363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner