Healthcare Provider Details

I. General information

NPI: 1871969626
Provider Name (Legal Business Name): HELENA DAVIS FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/17/2015
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9654 W 131ST ST UNIT 205
PALOS PARK IL
60464-1640
US

IV. Provider business mailing address

9654 W 131ST STREET UNIT 205
PALOS PARK IL
60464
US

V. Phone/Fax

Practice location:
  • Phone: 708-480-2650
  • Fax: 708-575-2876
Mailing address:
  • Phone: 773-844-6869
  • Fax: 708-575-2876

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number209013064
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number209013064
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: