Provider Demographics
NPI:1225038201
Name:DAVISON, TONI M (PA-C)
Entity Type:Individual
Prefix:MS
First Name:TONI
Middle Name:M
Last Name:DAVISON
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MS
Other - First Name:TONI
Other - Middle Name:M
Other - Last Name:DAVISION
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PA-C
Mailing Address - Street 1:1120 WELLINGTON AVE
Mailing Address - Street 2:SUITE 204
Mailing Address - City:GRAND JUNCTION
Mailing Address - State:CO
Mailing Address - Zip Code:81501-6129
Mailing Address - Country:US
Mailing Address - Phone:970-241-0170
Mailing Address - Fax:970-241-2035
Practice Address - Street 1:1120 WELLINGTON AVE
Practice Address - Street 2:SUITE 204
Practice Address - City:GRAND JUNCTION
Practice Address - State:CO
Practice Address - Zip Code:81501-6129
Practice Address - Country:US
Practice Address - Phone:970-241-0170
Practice Address - Fax:970-241-2035
Is Sole Proprietor?:No
Enumeration Date:2005-07-29
Last Update Date:2007-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO559363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
COC265528Medicare PIN
COS58794Medicare UPIN