Provider Demographics
NPI:1821101288
Name:DAVIS, NANCY R (APRN,BC)
Entity Type:Individual
Prefix:MS
First Name:NANCY
Middle Name:R
Last Name:DAVIS
Suffix:
Gender:F
Credentials:APRN,BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:359 N 300 W
Mailing Address - Street 2:
Mailing Address - City:ST GEORGE
Mailing Address - State:UT
Mailing Address - Zip Code:84770-2727
Mailing Address - Country:US
Mailing Address - Phone:435-229-1560
Mailing Address - Fax:435-487-1555
Practice Address - Street 1:359 N 300 W
Practice Address - Street 2:
Practice Address - City:ST GEORGE
Practice Address - State:UT
Practice Address - Zip Code:84770-2727
Practice Address - Country:US
Practice Address - Phone:435-229-1560
Practice Address - Fax:435-487-1555
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-17
Last Update Date:2016-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT1908224405363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
UTD1779Medicaid
UTS56978Medicare UPIN
UTD1779Medicaid