Provider Demographics
NPI:1306842364
Name:DAVISON, IRMA LOUISE (FNP)
Entity Type:Individual
Prefix:MRS
First Name:IRMA
Middle Name:LOUISE
Last Name:DAVISON
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5749 E BUTLER AVE
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93727-5410
Mailing Address - Country:US
Mailing Address - Phone:559-252-5177
Mailing Address - Fax:
Practice Address - Street 1:3103 E CARTWRIGHT AVE
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93725-9385
Practice Address - Country:US
Practice Address - Phone:559-498-7100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-06-24
Last Update Date:2016-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA332222363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily