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NPI Code Detail

MEDICARE: STEPHANIE WILSON DAVIS RN, MSN

MEDICARE: STEPHANIE WILSON DAVIS RN, MSN
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363L00000XNurse Practitioner5012785NC
2363L00000XNurse Practitioner2001029398MO

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1033176714
Entity Type Code : Individual
Provider Name (Legal Business Name) : STEPHANIE WILSON DAVIS RN, MSN
Provider Business Mailing Address
First Line : 200 E 2ND AVE
Second Line :
City : GASTONIA
State : NC
Zip : 28052-4358
Country : US
Telephone Number : 704-874-1904
Fax Number :
Provider Business Practice Location Address
First Line : 4555 OGBURN AVE
Second Line :
City : WINSTON SALEM
State : NC
Zip : 27105-2726
Country : US
Telephone Number : 336-703-4273
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/27/2006
Last Update Date : 02/19/2020

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