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General NPI Number Information
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NPI Number | 1083964274
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Entity Type | Individual
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Provider Name | SEAN DAVIES APRN
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Gender | Male
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Dates
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Enumeration Date | 09/14/2012
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Last Update Date | 06/25/2023
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Provider Practice Location Address
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Address Line | 1241 EAST ST. JOSEPH ST
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City | RAPID CITY
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State | SD
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Zip | 57701-3199
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Country | US
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Telephone | 573-310-8473
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Fax | 314-820-0336
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Provider Business Mailing Address
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Address Line | 514 AMERICAS WAY #8806
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City | BOX ELDER
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State | SD
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Zip | 57719
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Country | US
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Telephone | 573-310-8473
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | CP001800
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License Number State | SD
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