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General NPI Number Information
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NPI Number | 1679222681
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Entity Type | Individual
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Provider Name | NICOLE ANN DAVIDSON ND
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Gender | Female
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Dates
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Enumeration Date | 03/18/2022
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Last Update Date | 03/18/2022
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Provider Practice Location Address
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Address Line | 14 LAZY G RD
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City | LARAMIE
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State | WY
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Zip | 82070-8852
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Country | US
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Telephone | 307-761-4848
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Fax |
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Provider Business Mailing Address
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Address Line | 14 LAZY G RD
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City | LARAMIE
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State | WY
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Zip | 82070-8852
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Country | US
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Telephone | 307-761-4848
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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 | 175F00000X
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Taxonomy Name | Naturopath
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License Number | AHC-NAT-LIC-2340
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License Number State | MT
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