Provider Demographics
NPI:1851522387
Name:DAVIS, HEATHER V (NMD)
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:V
Last Name:DAVIS
Suffix:
Gender:F
Credentials:NMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 10337
Mailing Address - Street 2:
Mailing Address - City:PRESCOTT
Mailing Address - State:AZ
Mailing Address - Zip Code:86304-0337
Mailing Address - Country:US
Mailing Address - Phone:928-362-1621
Mailing Address - Fax:928-304-7162
Practice Address - Street 1:140 N MONTEZUMA ST
Practice Address - Street 2:STE 102
Practice Address - City:PRESCOTT
Practice Address - State:AZ
Practice Address - Zip Code:86301-3006
Practice Address - Country:US
Practice Address - Phone:928-362-1621
Practice Address - Fax:928-304-7162
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-31
Last Update Date:2014-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIND188175F00000X
AZ09-1127175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath