Provider Demographics
NPI:1407849201
Name:DAVIS, CORI MICHELLE (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:CORI
Middle Name:MICHELLE
Last Name:DAVIS
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2106 W COVENTRY LN
Mailing Address - Street 2:
Mailing Address - City:ENOLA
Mailing Address - State:PA
Mailing Address - Zip Code:17025-1277
Mailing Address - Country:US
Mailing Address - Phone:717-514-9676
Mailing Address - Fax:
Practice Address - Street 1:3399 TRINDLE RD
Practice Address - Street 2:
Practice Address - City:CAMP HILL
Practice Address - State:PA
Practice Address - Zip Code:17011-4407
Practice Address - Country:US
Practice Address - Phone:717-761-5530
Practice Address - Fax:717-737-7197
Is Sole Proprietor?:No
Enumeration Date:2005-08-26
Last Update Date:2021-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA052373363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAMA052373OtherPA STATE LICENSE
1056473OtherNCCPA CERTIFICATION
PAP71393Medicare UPIN
1056473OtherNCCPA CERTIFICATION