Healthcare Provider Details

I. General information

NPI: 1437815214
Provider Name (Legal Business Name): ANNETTE DAVIS FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/16/2021
Last Update Date: 11/16/2021
Certification Date: 11/16/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19875 N 51ST AVE
GLENDALE AZ
85308-5114
US

IV. Provider business mailing address

19875 N 51ST AVE
GLENDALE AZ
85308-5114
US

V. Phone/Fax

Practice location:
  • Phone: 623-581-8998
  • Fax: 623-581-6461
Mailing address:
  • Phone: 623-581-8998
  • Fax: 623-581-6461

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number264862
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: