Healthcare Provider Details

I. General information

NPI: 1821171786
Provider Name (Legal Business Name): JAN WAYMENT DAVIS APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JAN WAYMENT DAVIS RNFA

II. Dates (important events)

Enumeration Date: 10/23/2006
Last Update Date: 01/14/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5290 S 400 E
OGDEN UT
84405-7194
US

IV. Provider business mailing address

5860 W 1400 N
OGDEN UT
84404-9023
US

V. Phone/Fax

Practice location:
  • Phone: 801-476-1777
  • Fax: 801-479-1479
Mailing address:
  • Phone: 801-391-7506
  • Fax: 801-731-4652

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WR0006X
TaxonomyRegistered Nurse First Assistant
License Number206166-3102
License Number StateUT
# 2
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number206166-4408
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: