=====================================================
General NPI Number Information
=====================================================
NPI Number | 1932249620
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ELIZABETH CATHERINE DAVIS FNP
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/08/2007
-----------------------------------------------------
Last Update Date | 07/25/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 801 S HAM LN SUITE 5
-----------------------------------------------------
City | LODI
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95242-7501
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 209-334-2448
-----------------------------------------------------
Fax | 209-333-1029
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1691 THE ALAMEDA
-----------------------------------------------------
City | SAN JOSE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95126-2203
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 408-287-7532
-----------------------------------------------------
Fax | 408-287-0405
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number | NP13338
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------