Healthcare Provider Details

I. General information

NPI: 1396210605
Provider Name (Legal Business Name): NICOLE JOY DAVIS REGISTERED NURSE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/12/2018
Last Update Date: 10/12/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2970 PAWNEE CT
REDDING CA
96001-3482
US

IV. Provider business mailing address

2970 PAWNEE CT
REDDING CA
96001-3482
US

V. Phone/Fax

Practice location:
  • Phone: 530-941-6472
  • Fax:
Mailing address:
  • Phone: 530-941-6472
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0000X
TaxonomyPain Management Registered Nurse
License Number584292
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: