Healthcare Provider Details

I. General information

NPI: 1699285007
Provider Name (Legal Business Name): JOANNA MAE DAVIS RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: JOANNA MAE DAVIS RN

II. Dates (important events)

Enumeration Date: 10/11/2017
Last Update Date: 10/11/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

150 MUIR RD
MARTINEZ CA
94553-4668
US

IV. Provider business mailing address

3999 CENTRAL LN
WINTERS CA
95694-9605
US

V. Phone/Fax

Practice location:
  • Phone: 925-370-4704
  • Fax:
Mailing address:
  • Phone: 530-771-7052
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WG0000X
TaxonomyGeneral Practice Registered Nurse
License Number779934
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: