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General NPI Number Information
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NPI Number | 1649483868
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Entity Type | Individual
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Provider Name | DENETTE DAVIS RN, PHN
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Gender | Female
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Dates
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Enumeration Date | 05/07/2007
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Last Update Date | 01/31/2017
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Provider Practice Location Address
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Address Line | 3795 W DAKOTA AVE
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City | FRESNO
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State | CA
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Zip | 93722-4784
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Country | US
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Telephone | 559-790-3310
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Fax |
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Provider Business Mailing Address
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Address Line | 3795 W DAKOTA AVE
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City | FRESNO
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State | CA
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Zip | 93722-4784
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Country | US
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Telephone | 559-790-3310
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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 | 163WC1500X
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Taxonomy Name | Community Health Registered Nurse
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License Number | 70385
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 163WH0200X
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Taxonomy Name | Home Health Registered Nurse
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License Number | 683475
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License Number State | CA
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