Provider Demographics
NPI:1831735745
Name:DAVENPORT, VERONICA ALEJANDRA (RN)
Entity type:Individual
Prefix:
First Name:VERONICA
Middle Name:ALEJANDRA
Last Name:DAVENPORT
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3925 W TONOPAH DR
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85308-4756
Mailing Address - Country:US
Mailing Address - Phone:520-419-8837
Mailing Address - Fax:
Practice Address - Street 1:15778 W YUMA RD
Practice Address - Street 2:
Practice Address - City:GOODYEAR
Practice Address - State:AZ
Practice Address - Zip Code:85338-3358
Practice Address - Country:US
Practice Address - Phone:623-932-7500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-11-26
Last Update Date:2019-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ232986163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse