Healthcare Provider Details

I. General information

NPI: 1255765053
Provider Name (Legal Business Name): ERICA DAVIS RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/28/2013
Last Update Date: 08/28/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10065 E HARVARD AVE SUIT 400
DENVER CO
80231-5968
US

IV. Provider business mailing address

1821 PACIFIC COAST HWY UNIT 40
HERMOSA BEACH CA
90254-3129
US

V. Phone/Fax

Practice location:
  • Phone: 303-614-1400
  • Fax:
Mailing address:
  • Phone: 310-922-5630
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number1621206
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code163WC0200X
TaxonomyCritical Care Medicine Registered Nurse
License Number713375
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: