Provider Demographics
NPI:1396203709
Name:DAVIS, VICTORIA ANN
Entity Type:Individual
Prefix:
First Name:VICTORIA
Middle Name:ANN
Last Name:DAVIS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 143
Mailing Address - Street 2:
Mailing Address - City:SABIN
Mailing Address - State:MN
Mailing Address - Zip Code:56580-0143
Mailing Address - Country:US
Mailing Address - Phone:701-893-8301
Mailing Address - Fax:
Practice Address - Street 1:1340 ADMINISTRATION AVENUE
Practice Address - Street 2:
Practice Address - City:FARGO
Practice Address - State:ND
Practice Address - Zip Code:58105
Practice Address - Country:US
Practice Address - Phone:701-231-8624
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-05
Last Update Date:2019-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program