Healthcare Provider Details

I. General information

NPI: 1316904709
Provider Name (Legal Business Name): ALICE E DAVIS PHD, NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/28/2006
Last Update Date: 03/16/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1059 KILAUEA AVE STE A
HILO HI
96720-4290
US

IV. Provider business mailing address

50839 HANFORD RD
CANTON MI
48187-4618
US

V. Phone/Fax

Practice location:
  • Phone: 734-712-5606
  • Fax:
Mailing address:
  • Phone: 734-416-7060
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number4704200537
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: