Provider Demographics
NPI:1821171786
Name:DAVIS, JAN WAYMENT (APRN)
Entity Type:Individual
Prefix:
First Name:JAN
Middle Name:WAYMENT
Last Name:DAVIS
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:JAN
Other - Middle Name:WAYMENT
Other - Last Name:DAVIS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RNFA
Mailing Address - Street 1:5860 W 1400 N
Mailing Address - Street 2:
Mailing Address - City:OGDEN
Mailing Address - State:UT
Mailing Address - Zip Code:84404-9023
Mailing Address - Country:US
Mailing Address - Phone:801-391-7506
Mailing Address - Fax:801-731-4652
Practice Address - Street 1:5290 S 400 E
Practice Address - Street 2:
Practice Address - City:OGDEN
Practice Address - State:UT
Practice Address - Zip Code:84405-7194
Practice Address - Country:US
Practice Address - Phone:801-476-1777
Practice Address - Fax:801-479-1479
Is Sole Proprietor?:No
Enumeration Date:2006-10-23
Last Update Date:2010-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT206166-3102163WR0006X
UT206166-4408363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
No163WR0006XNursing Service ProvidersRegistered NurseRegistered Nurse First Assistant