Provider Demographics
NPI:1538131396
Name:DAVIS, PATRICIA (CNPF)
Entity Type:Individual
Prefix:MS
First Name:PATRICIA
Middle Name:
Last Name:DAVIS
Suffix:
Gender:F
Credentials:CNPF
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3400 N CENTER RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:SAGINAW
Mailing Address - State:MI
Mailing Address - Zip Code:48603-7919
Mailing Address - Country:US
Mailing Address - Phone:989-792-1494
Mailing Address - Fax:989-249-9941
Practice Address - Street 1:217 S MADISON ST
Practice Address - Street 2:
Practice Address - City:TRAVERSE CITY
Practice Address - State:MI
Practice Address - Zip Code:49684-2320
Practice Address - Country:US
Practice Address - Phone:231-392-8400
Practice Address - Fax:231-935-7888
Is Sole Proprietor?:No
Enumeration Date:2006-02-06
Last Update Date:2021-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704140341363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI08017574OtherRAILROAD MEDICARE
MI5008702440OtherBCBS MICHIGAN
MI5008702440OtherBCBS MICHIGAN
MI0N27340Medicare ID - Type Unspecified