Healthcare Provider Details

I. General information

NPI: 1083973663
Provider Name (Legal Business Name): HALEY RAE DAVIS MSN, NNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/16/2012
Last Update Date: 12/14/2021
Certification Date: 12/14/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7700 S BROADWAY
LITTLETON CO
80122-2602
US

IV. Provider business mailing address

7716 S MADISON CIR
CENTENNIAL CO
80122-3534
US

V. Phone/Fax

Practice location:
  • Phone: 303-730-8900
  • Fax:
Mailing address:
  • Phone: 919-698-5402
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LN0000X
TaxonomyNeonatal Nurse Practitioner
License Number5005602
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: