Healthcare Provider Details

I. General information

NPI: 1790840221
Provider Name (Legal Business Name): MICHELE L DAVIS LMP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/26/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

515 W FRANCIS AVE SUITE 8
SPOKANE WA
99205-6413
US

IV. Provider business mailing address

27217 N RATLIFF RD
CHATTAROY WA
99003-9527
US

V. Phone/Fax

Practice location:
  • Phone: 509-326-5762
  • Fax: 509-327-2198
Mailing address:
  • Phone: 509-251-2217
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171W00000X
TaxonomyContractor
License NumberMA99918149
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: