Provider Demographics
NPI:1043704216
Name:DAVIS, ELIZABETH ANN (NP)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:ANN
Last Name:DAVIS
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1660 SALMER ST
Mailing Address - Street 2:
Mailing Address - City:HOLLY
Mailing Address - State:MI
Mailing Address - Zip Code:48442-9188
Mailing Address - Country:US
Mailing Address - Phone:734-674-7044
Mailing Address - Fax:
Practice Address - Street 1:5400 FORT ST STE 130
Practice Address - Street 2:
Practice Address - City:TRENTON
Practice Address - State:MI
Practice Address - Zip Code:48183-4627
Practice Address - Country:US
Practice Address - Phone:734-362-7100
Practice Address - Fax:734-671-1768
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-20
Last Update Date:2019-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704244761363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4704244761OtherMICHIGAN LICENSE