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General NPI Number Information
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NPI Number | 1164561130
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Entity Type | Individual
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Provider Name | AMY M DAVIS APN FNP-C
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Gender | Female
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Dates
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Enumeration Date | 02/06/2007
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Last Update Date | 10/07/2024
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Provider Practice Location Address
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Address Line | 2338 W VAN WINKLE WAY STE 3300
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City | PEORIA
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State | IL
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Zip | 61615-7485
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Country | US
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Telephone | 309-693-2020
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Fax | 309-693-9769
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Provider Business Mailing Address
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Address Line | 5401 N KNOXVILLE AVE STE 207
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City | PEORIA
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State | IL
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Zip | 61614-5021
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Country | US
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Telephone | 309-692-0400
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Fax | 309-692-2804
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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 | 209006059
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License Number State | IL
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