MEDICARE: MARY A. DAVIS NP

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
1	363L00000X	Nurse Practitioner	3142	WI

General Provider Information

NPI Number	:	1851582357
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARY A. DAVIS NP

Provider Business Mailing Address
First Line	:	1000 N OAK AVE
Second Line	:
City	:	MARSHFIELD
State	:	WI
Zip	:	54449-5703
Country	:	US
Telephone Number	:	715-387-5511
Fax Number	:

Provider Business Practice Location Address
First Line	:	10212 N GREENWOOD LN
Second Line	:
City	:	HAYWARD
State	:	WI
Zip	:	54843-7220
Country	:	US
Telephone Number	:	715-634-6520
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/08/2007
Last Update Date	:	07/03/2012

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