Provider Demographics
NPI:1447230123
Name:DAVENPORT, NICHOLAS ANTONY (MD, MPH)
Entity Type:Individual
Prefix:DR
First Name:NICHOLAS
Middle Name:ANTONY
Last Name:DAVENPORT
Suffix:
Gender:M
Credentials:MD, MPH
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 1244
Mailing Address - Street 2:
Mailing Address - City:MUKILTEO
Mailing Address - State:WA
Mailing Address - Zip Code:98275-1244
Mailing Address - Country:US
Mailing Address - Phone:425-512-9764
Mailing Address - Fax:
Practice Address - Street 1:1465 SCURLOCK LN
Practice Address - Street 2:
Practice Address - City:MUKILTEO
Practice Address - State:WA
Practice Address - Zip Code:98275-1734
Practice Address - Country:US
Practice Address - Phone:425-512-9764
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-19
Last Update Date:2014-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD000254572083A0100X, 2083X0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083A0100XAllopathic & Osteopathic PhysiciansPreventive MedicineAerospace Medicine
No2083X0100XAllopathic & Osteopathic PhysiciansPreventive MedicineOccupational Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
BD7015527OtherFEDERAL DEA NUMBER