Provider Demographics
NPI:1518054436
Name:DAVIS, CAMMIE A (FNP)
Entity Type:Individual
Prefix:MRS
First Name:CAMMIE
Middle Name:A
Last Name:DAVIS
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1820 E 54TH ST STE B
Mailing Address - Street 2:
Mailing Address - City:DAVENPORT
Mailing Address - State:IA
Mailing Address - Zip Code:52807
Mailing Address - Country:US
Mailing Address - Phone:563-355-9990
Mailing Address - Fax:563-355-9999
Practice Address - Street 1:1820 E 54TH ST STE B
Practice Address - Street 2:
Practice Address - City:DAVENPORT
Practice Address - State:IA
Practice Address - Zip Code:52807
Practice Address - Country:US
Practice Address - Phone:563-355-9990
Practice Address - Fax:563-355-9999
Is Sole Proprietor?:No
Enumeration Date:2006-10-10
Last Update Date:2011-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAA088029363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
I3991Medicare ID - Type Unspecified
I3990Medicare UPIN