Healthcare Provider Details

I. General information

NPI: 1003659871
Provider Name (Legal Business Name): MADISON DAVIS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/18/2024
Last Update Date: 08/14/2026
Certification Date: 08/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16706 137TH AVE E
PUYALLUP WA
98374-9233
US

IV. Provider business mailing address

5410 N 44TH ST
TACOMA WA
98407-3715
US

V. Phone/Fax

Practice location:
  • Phone: 253-237-4420
  • Fax:
Mailing address:
  • Phone: 253-759-9544
  • 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: