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General NPI Number Information
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NPI Number | 1255459798
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Entity Type | Individual
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Provider Name | JUDY DAVIS RN
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Gender | Female
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Dates
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Enumeration Date | 03/26/2007
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Last Update Date | 03/25/2013
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Provider Practice Location Address
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Address Line | 11194 W HIGHMONT DR
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City | BOISE
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State | ID
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Zip | 83709-7703
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Country | US
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Telephone | 208-376-3446
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Fax |
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Provider Business Mailing Address
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Address Line | 11194 W HIGHMONT DR
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City | BOISE
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State | ID
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Zip | 83709-7703
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Country | US
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Telephone | 208-376-3446
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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 | 163WD0400X
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Taxonomy Name | Diabetes Educator Registered Nurse
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License Number | N-18690
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License Number State | ID
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