Provider Demographics
NPI:1184107021
Name:DAVIS, DANIEL (DNP, CPNP-AC, CCRN)
Entity type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:
Last Name:DAVIS
Suffix:
Gender:M
Credentials:DNP, CPNP-AC, CCRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:707 LEAHY ST APT 224
Mailing Address - Street 2:
Mailing Address - City:REDWOOD CITY
Mailing Address - State:CA
Mailing Address - Zip Code:94061-3949
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3701 CORRIERE RD STE 10
Practice Address - Street 2:
Practice Address - City:EASTON
Practice Address - State:PA
Practice Address - Zip Code:18045-7991
Practice Address - Country:US
Practice Address - Phone:484-591-7205
Practice Address - Fax:484-591-7206
Is Sole Proprietor?:No
Enumeration Date:2018-09-06
Last Update Date:2020-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP020217363LP0200X
CA841866163WP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0200XNursing Service ProvidersRegistered NursePediatrics
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics