Healthcare Provider Details

I. General information

NPI: 1225038201
Provider Name (Legal Business Name): TONI M DAVISON P.A.-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: TONI M. DAVISION P.A.-C

II. Dates (important events)

Enumeration Date: 07/29/2005
Last Update Date: 12/04/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1120 WELLINGTON AVE SUITE 204
GRAND JUNCTION CO
81501-6129
US

IV. Provider business mailing address

1120 WELLINGTON AVE SUITE 204
GRAND JUNCTION CO
81501-6129
US

V. Phone/Fax

Practice location:
  • Phone: 970-241-0170
  • Fax: 970-241-2035
Mailing address:
  • Phone: 970-241-0170
  • Fax: 970-241-2035

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number559
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: