Provider Demographics
NPI:1639398357
Name:DAVIS, JEANNE ANN (FNP)
Entity Type:Individual
Prefix:MRS
First Name:JEANNE
Middle Name:ANN
Last Name:DAVIS
Suffix:
Gender:F
Credentials:FNP
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Mailing Address - Street 1:2695 ROCKY MOUNTAIN AVE
Mailing Address - Street 2:SUITE 150
Mailing Address - City:LOVELAND
Mailing Address - State:CO
Mailing Address - Zip Code:80538-8702
Mailing Address - Country:US
Mailing Address - Phone:970-624-4443
Mailing Address - Fax:970-490-4175
Practice Address - Street 1:620 IRIS DR
Practice Address - Street 2:
Practice Address - City:STERLING
Practice Address - State:CO
Practice Address - Zip Code:80751-4716
Practice Address - Country:US
Practice Address - Phone:970-522-7266
Practice Address - Fax:970-522-4258
Is Sole Proprietor?:No
Enumeration Date:2007-04-24
Last Update Date:2013-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO46792363LA2200X
CONP-1966363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
COCOA106286Medicare PIN