Provider Demographics
NPI:1174637680
Name:DAVIS, ANNETTE TR (NP)
Entity Type:Individual
Prefix:MRS
First Name:ANNETTE
Middle Name:TR
Last Name:DAVIS
Suffix:
Gender:F
Credentials:NP
Other - Prefix:MRS
Other - First Name:ANNETTE
Other - Middle Name:
Other - Last Name:ROSSI-DAVIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:777 BANNOCK ST
Mailing Address - Street 2:MC 0188
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80204-4507
Mailing Address - Country:US
Mailing Address - Phone:303-043-6600
Mailing Address - Fax:
Practice Address - Street 1:777 BANNOCK ST
Practice Address - Street 2:MC 0188
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80204-4507
Practice Address - Country:US
Practice Address - Phone:303-043-6600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-19
Last Update Date:2016-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO55987363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
COP25958Medicare UPIN
COP25958Medicare UPIN