Provider Demographics
NPI:1649483868
Name:DAVIS, DENETTE (RN, PHN)
Entity type:Individual
Prefix:
First Name:DENETTE
Middle Name:
Last Name:DAVIS
Suffix:
Gender:F
Credentials:RN, PHN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3795 W DAKOTA AVE
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93722-4784
Mailing Address - Country:US
Mailing Address - Phone:559-790-3310
Mailing Address - Fax:
Practice Address - Street 1:3795 W DAKOTA AVE
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93722-4784
Practice Address - Country:US
Practice Address - Phone:559-790-3310
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-07
Last Update Date:2017-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA70385163WC1500X
CA683475163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health
No163WC1500XNursing Service ProvidersRegistered NurseCommunity Health