Provider Demographics
NPI:1558421719
Name:DAVIS, JUDY A (APN,FNP)
Entity Type:Individual
Prefix:
First Name:JUDY
Middle Name:A
Last Name:DAVIS
Suffix:
Gender:F
Credentials:APN,FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:UIC COLLEGE OF NURSING PMA(MC802).
Mailing Address - Street 2:845 S. DAMEN AVE SUITE 1058
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60612-7350
Mailing Address - Country:US
Mailing Address - Phone:773-996-5800
Mailing Address - Fax:773-996-9049
Practice Address - Street 1:1110 W BELMONT AVENUE
Practice Address - Street 2:MOTHERS PROGRAMTHRESHOLDS
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60657
Practice Address - Country:US
Practice Address - Phone:773-472-3558
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL544480Medicare ID - Type Unspecified