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General NPI Number Information
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NPI Number | 1821552761
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Entity Type | Individual
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Provider Name | TARYRSHA DAVIS APN
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Gender | Female
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Dates
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Enumeration Date | 01/24/2019
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Last Update Date | 12/04/2021
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Provider Practice Location Address
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Address Line | 620 N RIVER RD STE 106
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City | NAPERVILLE
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State | IL
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Zip | 60563-8951
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Country | US
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Telephone | 630-364-2484
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Fax | 630-536-8511
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Provider Business Mailing Address
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Address Line | 620 N RIVER RD STE 106
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City | NAPERVILLE
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State | IL
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Zip | 60563-8951
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Country | US
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Telephone | 630-364-2484
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Fax | 630-536-8511
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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 | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 209.023614
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 209.018789
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License Number State | IL
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