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NPI Code Detail

MEDICARE: NANCY DAVIS CRNA

MEDICARE:   NANCY  DAVIS  CRNA
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
1207L00000XAnesthesiology Physician041145437IL

General Provider Information

NPI Number : 1144217472
Entity Type Code : Individual
Provider Name (Legal Business Name) : NANCY DAVIS CRNA
Provider Business Mailing Address
First Line : 401W GROVE ST
Second Line :
City : PONTIAC
State : IL
Zip : 61764-2411
Country : US
Telephone Number : 815-302-6479
Fax Number :
Provider Business Practice Location Address
First Line : 2200 FORT JESSE RD
Second Line : SUITE 240
City : NORMAL
State : IL
Zip : 61761-6286
Country : US
Telephone Number : 309-268-9300
Fax Number : 309-268-0575
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/03/2005
Last Update Date : 08/24/2015

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Directions to “ NANCY DAVIS CRNA” Practice Location

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