Healthcare Provider Details

I. General information

NPI: 1306750658
Provider Name (Legal Business Name): RYAN THOMAS DAVIDSON RN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/01/2026
Last Update Date: 10/01/2026
Certification Date: 10/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2767 OLIVE HWY
OROVILLE CA
95966-6103
US

IV. Provider business mailing address

PO BOX 81
BROWNS VALLEY CA
95918-0081
US

V. Phone/Fax

Practice location:
  • Phone: 530-532-8500
  • Fax:
Mailing address:
  • Phone: 530-532-8211
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC0200X
TaxonomyCritical Care Medicine Registered Nurse
License Number683640
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: