Provider Demographics
NPI:1790813285
Name:DAVIES, AMY BETH (NP)
Entity Type:Individual
Prefix:MRS
First Name:AMY
Middle Name:BETH
Last Name:DAVIES
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:AMY
Other - Middle Name:
Other - Last Name:DAVIES
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:11213 SAND HILL DR
Mailing Address - Street 2:
Mailing Address - City:GRASS LAKE
Mailing Address - State:MI
Mailing Address - Zip Code:49240-9688
Mailing Address - Country:US
Mailing Address - Phone:517-522-6598
Mailing Address - Fax:
Practice Address - Street 1:500 LANSING AVE
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MI
Practice Address - Zip Code:49201-2820
Practice Address - Country:US
Practice Address - Phone:517-787-7805
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704215004207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine