Healthcare Provider Details

I. General information

NPI: 1811309966
Provider Name (Legal Business Name): CARA DAVELAAR RN, BSN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/23/2014
Last Update Date: 05/23/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

42147 N MOUNTAIN COVE DR
ANTHEM AZ
85086-1987
US

IV. Provider business mailing address

42147 N MOUNTAIN COVE DR
ANTHEM AZ
85086-1987
US

V. Phone/Fax

Practice location:
  • Phone: 623-445-7410
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WS0200X
TaxonomySchool Registered Nurse
License NumberRN181606
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: