Provider Demographics
NPI:1528389038
Name:DAVIS, ANNA M (NP)
Entity Type:Individual
Prefix:
First Name:ANNA
Middle Name:M
Last Name:DAVIS
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9910 FRANKLIN SQUARE DR
Mailing Address - Street 2:# 2110
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21236-4902
Mailing Address - Country:US
Mailing Address - Phone:602-674-6575
Mailing Address - Fax:602-674-6773
Practice Address - Street 1:8620 N 22ND AVE
Practice Address - Street 2:STE 200
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85021-4251
Practice Address - Country:US
Practice Address - Phone:202-877-7000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-06-18
Last Update Date:2018-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDAC002156363L00000X
AZAP4397363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ723028Medicaid