Healthcare Provider Details

I. General information

NPI: 1265090922
Provider Name (Legal Business Name): NINA DAVIS NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: NINA SCHAFER

II. Dates (important events)

Enumeration Date: 05/29/2019
Last Update Date: 09/04/2026
Certification Date: 09/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1247 E MOCKINGBIRD LN
SANDY UT
84094-3118
US

IV. Provider business mailing address

1247 E MOCKINGBIRD LN
SANDY UT
84094-3118
US

V. Phone/Fax

Practice location:
  • Phone: 419-366-8406
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number10560013-4405
License Number StateUT
# 2
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number10560013-1302
License Number StateUT
# 3
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number816789
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: