Healthcare Provider Details

I. General information

NPI: 1194300889
Provider Name (Legal Business Name): ANALISA DAVIDSON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/14/2021
Last Update Date: 08/17/2026
Certification Date: 08/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8084 ROAD 11.5 NW
EPHRATA WA
98823-9487
US

IV. Provider business mailing address

8084 ROAD 11.5 NW
EPHRATA WA
98823-9487
US

V. Phone/Fax

Practice location:
  • Phone: 509-770-0640
  • Fax:
Mailing address:
  • Phone: 509-770-0640
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: