Provider Demographics
NPI:1700028602
Name:DAVIS, AMANDA D (PA)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:D
Last Name:DAVIS
Suffix:
Gender:F
Credentials:PA
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Mailing Address - Street 1:2940 E. GATEWAY DRIVE
Mailing Address - Street 2:SUITE #450
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85234
Mailing Address - Country:US
Mailing Address - Phone:480-256-6444
Mailing Address - Fax:480-256-4734
Practice Address - Street 1:2946 E. BANNER GATEWAY DRIVE
Practice Address - Street 2:SUITE 450
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85234
Practice Address - Country:US
Practice Address - Phone:480-256-6444
Practice Address - Fax:480-256-4734
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-24
Last Update Date:2015-03-06
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
AZ3760363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant