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NPI Code Detail

MEDICARE: ALEXANDRIA DAVIS

MEDICARE: ALEXANDRIA DAVIS
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363LP0808XPsychiatric/Mental Health Nurse Practitioner209.016255IL

General Provider Information

NPI Number : 1255856951
Entity Type Code : Individual
Provider Name (Legal Business Name) : ALEXANDRIA DAVIS
Provider Business Mailing Address
First Line : 8500 S ESSEX AVE
Second Line :
City : CHICAGO
State : IL
Zip : 60617-2333
Country : US
Telephone Number : 708-408-6022
Fax Number :
Provider Business Practice Location Address
First Line : 5555 S WOODLAWN AVE
Second Line :
City : CHICAGO
State : IL
Zip : 60637-1620
Country : US
Telephone Number : 773-702-9800
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/03/2017
Last Update Date : 01/03/2020

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