Provider Demographics
NPI:1487833109
Name:DAVIS, JENNIFER S (NP)
Entity Type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:S
Last Name:DAVIS
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:BALL STATE UNIVERSITY STUDENT HEALTH CENTER
Mailing Address - Street 2:1500 NEELY AVENUE
Mailing Address - City:MUNCIE
Mailing Address - State:IN
Mailing Address - Zip Code:47306-0001
Mailing Address - Country:US
Mailing Address - Phone:765-285-8971
Mailing Address - Fax:
Practice Address - Street 1:BALL STATE UNIVERSITY STUDENT HEALTH CENTER
Practice Address - Street 2:1500 NEELY AVE.
Practice Address - City:MUNCIE
Practice Address - State:IN
Practice Address - Zip Code:47306-0001
Practice Address - Country:US
Practice Address - Phone:765-285-8971
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-10-30
Last Update Date:2007-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71001185B363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
INP73291Medicare UPIN