Healthcare Provider Details

I. General information

NPI: 1215874714
Provider Name (Legal Business Name): NANCY ANN DAVIS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/01/2026
Last Update Date: 05/01/2026
Certification Date: 05/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1482 BROADWAY AVE
ATWATER CA
95301-3547
US

IV. Provider business mailing address

2520 GIANNINI RD
ATWATER CA
95301-9541
US

V. Phone/Fax

Practice location:
  • Phone: 209-326-0767
  • Fax:
Mailing address:
  • Phone: 209-769-1477
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number65253
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: