MEDICARE: MS. DOLORES M. DAVIS FNP

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
1	363LF0000X	Family Nurse Practitioner	348642	CA

General Provider Information

NPI Number	:	1093783151
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. DOLORES M. DAVIS FNP

Provider Business Mailing Address
First Line	:	PO BOX 1669
Second Line	:
City	:	MARIPOSA
State	:	CA
Zip	:	95338-1669
Country	:	US
Telephone Number	:	209-966-5501
Fax Number	:	559-228-5309

Provider Business Practice Location Address
First Line	:	2615 E CLINTON AVE
Second Line	:	SURGICAL SECTION #112
City	:	FRESNO
State	:	CA
Zip	:	93703-2223
Country	:	US
Telephone Number	:	559-228-5366
Fax Number	:	559-228-5309

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/14/2006
Last Update Date	:	07/08/2007

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