Provider Demographics
NPI:1881847556
Name:DAVIS, SUSAN LESLIE (CHP)
Entity Type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:LESLIE
Last Name:DAVIS
Suffix:
Gender:F
Credentials:CHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3380 C ST STE 100
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99503-3949
Mailing Address - Country:US
Mailing Address - Phone:907-277-1440
Mailing Address - Fax:907-277-1446
Practice Address - Street 1:172 MAIN STREET
Practice Address - Street 2:
Practice Address - City:SAND POINT
Practice Address - State:AK
Practice Address - Zip Code:99661-0172
Practice Address - Country:US
Practice Address - Phone:907-383-3151
Practice Address - Fax:907-383-5688
Is Sole Proprietor?:No
Enumeration Date:2008-10-28
Last Update Date:2019-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK08-983-P172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
AK174400000XOtherSPECIALIST