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General NPI Number Information
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NPI Number | 1982289625
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Entity Type | Individual
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Provider Name | CALLIE DAVIDSON NURSE PRACTITIONER
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Gender | Female
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Dates
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Enumeration Date | 03/15/2021
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Last Update Date | 03/09/2022
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Provider Practice Location Address
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Address Line | 1120 MINNEQUA AVE
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City | PUEBLO
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State | CO
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Zip | 81004-3734
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Country | US
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Telephone | 719-281-3285
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Fax |
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Provider Business Mailing Address
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Address Line | 75 PRINTERS PKWY STE 200
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City | COLORADO SPRINGS
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State | CO
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Zip | 80910-3142
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | APN.0996306-NP
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License Number State | CO
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