Healthcare Provider Details

I. General information

NPI: 1003142118
Provider Name (Legal Business Name): JESSICA LYNN DAVIS N.P.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/23/2009
Last Update Date: 04/11/2025
Certification Date: 04/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2025 FORD AVE
WYANDOTTE MI
48192-2312
US

IV. Provider business mailing address

2025 FORD AVE
WYANDOTTE MI
48192-2312
US

V. Phone/Fax

Practice location:
  • Phone: 734-281-3080
  • Fax: 734-281-8815
Mailing address:
  • Phone: 734-281-3080
  • Fax: 734-281-8815

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number4704245661
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code363LC0200X
TaxonomyCritical Care Medicine Nurse Practitioner
License Number4704245661
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: