Provider Demographics
NPI:1780842252
Name:DAVIS, CAROL ELSA
Entity Type:Individual
Prefix:MRS
First Name:CAROL
Middle Name:ELSA
Last Name:DAVIS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8045 NORMANSHIRE CT
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99504
Mailing Address - Country:US
Mailing Address - Phone:907-332-1054
Mailing Address - Fax:907-332-1054
Practice Address - Street 1:8045 NORMANSHIRE CT
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99504
Practice Address - Country:US
Practice Address - Phone:907-332-1054
Practice Address - Fax:907-332-1054
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-30
Last Update Date:2008-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK431459310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility