Provider Demographics
NPI:1629518758
Name:DAVIS, MONZELLE OBRIAN (ACNPC-AG)
Entity Type:Individual
Prefix:
First Name:MONZELLE
Middle Name:OBRIAN
Last Name:DAVIS
Suffix:
Gender:M
Credentials:ACNPC-AG
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1119 PAUL EELLS DRIVE APT 106
Mailing Address - Street 2:
Mailing Address - City:NORTH LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72113
Mailing Address - Country:US
Mailing Address - Phone:501-467-4880
Mailing Address - Fax:
Practice Address - Street 1:11119 PAUL EELLS DR APT 106
Practice Address - Street 2:
Practice Address - City:NORTH LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72113-7532
Practice Address - Country:US
Practice Address - Phone:501-467-4880
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-03-08
Last Update Date:2017-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARA005077363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care