=====================================================
General NPI Number Information
=====================================================
NPI Number | 1144579806
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ALLISON FAIN DAVIS APRN
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/10/2012
-----------------------------------------------------
Last Update Date | 10/28/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 6355 S BUFFALO DR FL 3
-----------------------------------------------------
City | LAS VEGAS
-----------------------------------------------------
State | NV
-----------------------------------------------------
Zip | 89113-2133
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 702-479-4881
-----------------------------------------------------
Fax | 702-966-8662
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6355 S BUFFALO DR FL 3
-----------------------------------------------------
City | LAS VEGAS
-----------------------------------------------------
State | NV
-----------------------------------------------------
Zip | 89113-2133
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 702-216-3346
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LA2200X
-----------------------------------------------------
Taxonomy Name | Adult Health Nurse Practitioner
-----------------------------------------------------
License Number | APN.18008 RX
-----------------------------------------------------
License Number State | SC
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 363LA2200X
-----------------------------------------------------
Taxonomy Name | Adult Health Nurse Practitioner
-----------------------------------------------------
License Number | 810238
-----------------------------------------------------
License Number State | NV
-----------------------------------------------------