Provider Demographics
NPI:1184190621
Name:DAVIS, NANCY EVELYN (NP)
Entity Type:Individual
Prefix:
First Name:NANCY
Middle Name:EVELYN
Last Name:DAVIS
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:NANCY
Other - Middle Name:DAVIS
Other - Last Name:SCURLOCK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:4301 PLANTATION RIDGE LN
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27409-9236
Mailing Address - Country:US
Mailing Address - Phone:267-249-4349
Mailing Address - Fax:
Practice Address - Street 1:4301 PLANTATION RIDGE LN
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27409-9236
Practice Address - Country:US
Practice Address - Phone:267-249-4349
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-23
Last Update Date:2018-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PATP003774C363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health