Provider Demographics
NPI:1093783151
Name:DAVIS, DOLORES M (FNP)
Entity Type:Individual
Prefix:MS
First Name:DOLORES
Middle Name:M
Last Name:DAVIS
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 1669
Mailing Address - Street 2:
Mailing Address - City:MARIPOSA
Mailing Address - State:CA
Mailing Address - Zip Code:95338-1669
Mailing Address - Country:US
Mailing Address - Phone:209-966-5501
Mailing Address - Fax:559-228-5309
Practice Address - Street 1:2615 E CLINTON AVE
Practice Address - Street 2:SURGICAL SECTION #112
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93703-2223
Practice Address - Country:US
Practice Address - Phone:559-228-5366
Practice Address - Fax:559-228-5309
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA348642363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily