Healthcare Provider Details

I. General information

NPI: 1659762540
Provider Name (Legal Business Name): SCOTT ALAN DAVIS RN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/12/2015
Last Update Date: 02/12/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13438 W ORANGE CT
LITCHFIELD PARK AZ
85340-6309
US

IV. Provider business mailing address

13438 W ORANGE CT
LITCHFIELD PARK AZ
85340-6309
US

V. Phone/Fax

Practice location:
  • Phone: 916-606-2466
  • Fax:
Mailing address:
  • Phone: 916-606-2466
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN 175252
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code163WC0400X
TaxonomyCase Management Registered Nurse
License NumberRN 2616882
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code163WC0400X
TaxonomyCase Management Registered Nurse
License NumberRN 3381909
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: