Provider Demographics
NPI:1477877413
Name:DAVIS, DENISE N (LMP)
Entity Type:Individual
Prefix:
First Name:DENISE
Middle Name:N
Last Name:DAVIS
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1601 WILLIAM WAY STE A
Mailing Address - Street 2:
Mailing Address - City:MOUNT VERNON
Mailing Address - State:WA
Mailing Address - Zip Code:98273-2500
Mailing Address - Country:US
Mailing Address - Phone:360-424-8115
Mailing Address - Fax:360-428-0104
Practice Address - Street 1:1601 WILLIAM WAY STE A
Practice Address - Street 2:
Practice Address - City:MOUNT VERNON
Practice Address - State:WA
Practice Address - Zip Code:98273-2500
Practice Address - Country:US
Practice Address - Phone:360-424-8115
Practice Address - Fax:360-428-0104
Is Sole Proprietor?:No
Enumeration Date:2010-03-19
Last Update Date:2010-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00016641174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist