Healthcare Provider Details

I. General information

NPI: 1740621515
Provider Name (Legal Business Name): AMANDA ELAINE DAVIS NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: AMANDA ELAINE EGGLESTON NP

II. Dates (important events)

Enumeration Date: 07/09/2013
Last Update Date: 01/11/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2455 JEFFERSON BLVD
WEST SACRAMENTO CA
95691-5313
US

IV. Provider business mailing address

2455 JEFFERSON BLVD
WEST SACRAMENTO CA
95691-5313
US

V. Phone/Fax

Practice location:
  • Phone: 916-617-2377
  • Fax:
Mailing address:
  • Phone: 916-617-2377
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WP2201X
TaxonomyAmbulatory Care Registered Nurse
License Number797561
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number23245
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: