Provider Demographics
NPI:1558749481
Name:DAVIS, LAURIE K
Entity Type:Individual
Prefix:
First Name:LAURIE
Middle Name:K
Last Name:DAVIS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 900
Mailing Address - Street 2:
Mailing Address - City:BELCOURT
Mailing Address - State:ND
Mailing Address - Zip Code:58316-0900
Mailing Address - Country:US
Mailing Address - Phone:701-477-0927
Mailing Address - Fax:701-477-8785
Practice Address - Street 1:BUILDING 150 JOHN NORQUAY STREET
Practice Address - Street 2:
Practice Address - City:BELCOURT
Practice Address - State:ND
Practice Address - Zip Code:58316
Practice Address - Country:US
Practice Address - Phone:701-477-0927
Practice Address - Fax:701-477-8785
Is Sole Proprietor?:No
Enumeration Date:2015-05-12
Last Update Date:2015-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator