Provider Demographics
NPI:1588812804
Name:DAVIS, DANA J (WHNP-BC)
Entity Type:Individual
Prefix:
First Name:DANA
Middle Name:J
Last Name:DAVIS
Suffix:
Gender:F
Credentials:WHNP-BC
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Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:720 ESKENAZI AVE
Mailing Address - Street 2:THIRD FLOOR, FIFTH THIRD OFFICE BUILDING
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46202-5166
Mailing Address - Country:US
Mailing Address - Phone:317-880-5117
Mailing Address - Fax:317-880-0524
Practice Address - Street 1:720 ESKENAZI AVE
Practice Address - Street 2:THIRD FLOOR, FIFTH THIRD OFFICE BUILDING
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46202-5166
Practice Address - Country:US
Practice Address - Phone:317-880-5117
Practice Address - Fax:317-880-0524
Is Sole Proprietor?:No
Enumeration Date:2008-08-28
Last Update Date:2014-04-14
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OHNP09590363LW0102X
IN71004833A363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN201217190Medicaid