Healthcare Provider Details

I. General information

NPI: 1881825909
Provider Name (Legal Business Name): DEBBIE ANN DAVIS RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/06/2009
Last Update Date: 08/06/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

BLDG 4076, NEELEY ROAD
FT WAINWRIGHT AK
99703
US

IV. Provider business mailing address

2990 DAVIS RD APT E10
FAIRBANKS AK
99709-5262
US

V. Phone/Fax

Practice location:
  • Phone: 907-361-5594
  • Fax:
Mailing address:
  • Phone: 907-374-7833
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN175348
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code163WM0102X
TaxonomyMaternal Newborn Registered Nurse
License NumberRN175348
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: