Provider Demographics
NPI:1760810915
Name:DAVISON, ALISHIA (PA-C)
Entity Type:Individual
Prefix:
First Name:ALISHIA
Middle Name:
Last Name:DAVISON
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1051 ESSINGTON RD
Mailing Address - Street 2:SUITE 290
Mailing Address - City:JOLIET
Mailing Address - State:IL
Mailing Address - Zip Code:60435-2801
Mailing Address - Country:US
Mailing Address - Phone:815-773-0099
Mailing Address - Fax:815-773-0088
Practice Address - Street 1:1051 ESSINGTON RD
Practice Address - Street 2:SUITE 290
Practice Address - City:JOLIET
Practice Address - State:IL
Practice Address - Zip Code:60435-2801
Practice Address - Country:US
Practice Address - Phone:815-773-0099
Practice Address - Fax:815-773-0088
Is Sole Proprietor?:No
Enumeration Date:2013-10-25
Last Update Date:2014-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL085-004881363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant