Healthcare Provider Details

I. General information

NPI: 1073006045
Provider Name (Legal Business Name): HOLLY D DAVIS APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/13/2018
Last Update Date: 03/27/2024
Certification Date: 03/27/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5311 LIMESTONE RD
WILMINGTON DE
19808-1246
US

IV. Provider business mailing address

119 S MAIN ST
SAINT CHARLES MO
63301-2802
US

V. Phone/Fax

Practice location:
  • Phone: 302-295-0473
  • Fax: 888-346-8981
Mailing address:
  • Phone: 314-609-3435
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License NumberLP-0010745
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: