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NPI Code Detail

MEDICARE: MRS. MARY RAE DAVENPORT ANP

MEDICARE: MRS. MARY RAE DAVENPORT ANP
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
1363LA2200XAdult Health Nurse Practitioner75918CO

General Provider Information

NPI Number : 1114068582
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. MARY RAE DAVENPORT ANP
Provider Business Mailing Address
First Line : 2748 CROSSROADS BLVD
Second Line :
City : GRAND JUNCTION
State : CO
Zip : 81506-3933
Country : US
Telephone Number : 970-255-0900
Fax Number : 970-255-0901
Provider Business Practice Location Address
First Line : 2748 CROSSROADS BLVD
Second Line :
City : GRAND JUNCTION
State : CO
Zip : 81506-3933
Country : US
Telephone Number : 970-255-0900
Fax Number : 970-255-0901
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/09/2007
Last Update Date : 07/08/2007

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