Healthcare Provider Details

I. General information

NPI: 1649208562
Provider Name (Legal Business Name): MALIA F DAVIS NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/29/2006
Last Update Date: 07/16/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1701 W 72ND AVE
DENVER CO
80221-2721
US

IV. Provider business mailing address

1345 PLAZA CT N STE 1A
LAFAYETTE CO
80026-2832
US

V. Phone/Fax

Practice location:
  • Phone: 303-650-4460
  • Fax:
Mailing address:
  • Phone: 303-665-3036
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number160971
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: