Healthcare Provider Details

I. General information

NPI: 1871912865
Provider Name (Legal Business Name): ALINA JOLENE DAVIS RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/07/2014
Last Update Date: 04/07/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

317 W FLORENCE AVE
FOWLER CO
81039-1043
US

IV. Provider business mailing address

317 W FLORENCE AVE
FOWLER CO
81039-1043
US

V. Phone/Fax

Practice location:
  • Phone: 719-469-9225
  • Fax:
Mailing address:
  • Phone: 719-469-9225
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN0192422
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: