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General NPI Number Information
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NPI Number | 1891886024
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Entity Type | Individual
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Provider Name | DIANE M PRIVITOR DAVIS FNP-C, PMHNPBC
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Gender | Female
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Dates
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Enumeration Date | 09/26/2006
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Last Update Date | 07/07/2021
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Provider Practice Location Address
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Address Line | 1501 STUBBS AVE
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City | MONROE
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State | LA
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Zip | 71201-7120
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Country | US
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Telephone | 318-816-5116
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Fax | 318-855-3429
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Provider Business Mailing Address
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Address Line | 200 WINTERPARK DR
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City | WEST MONROE
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State | LA
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Zip | 71292-1106
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Country | US
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Telephone | 318-509-8008
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Fax | 318-329-1258
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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 | AP05002
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License Number State | LA
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Taxonomy #2
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | APO5002
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License Number State | LA
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