Healthcare Provider Details

I. General information

NPI: 1609730506
Provider Name (Legal Business Name): RAVEN DAVIS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/15/2025
Last Update Date: 12/15/2025
Certification Date: 12/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

229 MAIN ST UNIT 7
HAINES AK
99827
US

IV. Provider business mailing address

PO BOX 1245
HAINES AK
99827-1245
US

V. Phone/Fax

Practice location:
  • Phone: 907-766-3200
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number245529
License Number StateAK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: