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General NPI Number Information
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NPI Number | 1972051423
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Entity Type | Individual
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Provider Name | STEPHANIE M DAVIS
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Gender | Female
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Dates
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Enumeration Date | 09/13/2016
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Last Update Date | 01/19/2026
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Provider Practice Location Address
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Address Line | 3525 E LOUISE DR STE 401
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City | MERIDIAN
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State | ID
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Zip | 83642-6303
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Country | US
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Telephone | 208-322-1680
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Fax | 208-322-1695
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Provider Business Mailing Address
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Address Line | 190 E BANNOCK ST
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City | BOISE
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State | ID
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Zip | 83712-6241
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Country | US
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Telephone |
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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 | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 4071397
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License Number State | ID
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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 | AP61515215
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License Number State | WA
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Taxonomy #3
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Taxonomy Code | 363LA2100X
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Taxonomy Name | Acute Care Nurse Practitioner
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License Number | 1682.1682
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License Number State | WY
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