Provider Demographics
NPI:1437112737
Name:DAVIS, PATRICIA A (ARNP)
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:A
Last Name:DAVIS
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:PATRICIA
Other - Middle Name:A
Other - Last Name:WARD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4820 D MILLUHR DR NE
Mailing Address - Street 2:
Mailing Address - City:OLYMPIA
Mailing Address - State:WA
Mailing Address - Zip Code:98516-2310
Mailing Address - Country:US
Mailing Address - Phone:360-413-0515
Mailing Address - Fax:
Practice Address - Street 1:3333 HARRISON AVE NW
Practice Address - Street 2:
Practice Address - City:OLYMPIA
Practice Address - State:WA
Practice Address - Zip Code:98502-5049
Practice Address - Country:US
Practice Address - Phone:360-704-2362
Practice Address - Fax:360-357-8823
Is Sole Proprietor?:No
Enumeration Date:2006-04-08
Last Update Date:2008-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP30006263363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAA007OtherTRICARE
WA9635368Medicaid
WA8110DAOtherREGENCE
WA9635368Medicaid