Healthcare Provider Details

I. General information

NPI: 1881839967
Provider Name (Legal Business Name): JULIE ANNETTE DAVIS RN CSN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/03/2008
Last Update Date: 12/03/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4735 W MORTEN AVE
GLENDALE AZ
85301-1560
US

IV. Provider business mailing address

4735 W MORTEN AVE
GLENDALE AZ
85301-1560
US

V. Phone/Fax

Practice location:
  • Phone: 623-707-2103
  • Fax: 623-707-2204
Mailing address:
  • Phone: 623-707-2103
  • Fax: 623-707-2204

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WP0200X
TaxonomyPediatric Registered Nurse
License NumberRN069064
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code163WS0200X
TaxonomySchool Registered Nurse
License NumberSN0967
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: