Healthcare Provider Details

I. General information

NPI: 1740243997
Provider Name (Legal Business Name): KAREN K DAVIS NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/10/2006
Last Update Date: 07/16/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

820 S DAMEN AVE JBVAMC (11F)
CHICAGO IL
60612-3728
US

IV. Provider business mailing address

820 S DAMEN AVE JBVAMC WOMEN'S PROGRAM
CHICAGO IL
60612-3728
US

V. Phone/Fax

Practice location:
  • Phone: 312-569-7369
  • Fax: 312-569-7522
Mailing address:
  • Phone: 312-569-7369
  • Fax: 312-569-7522

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: