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NPI Code Detail

MEDICARE: MRS. JENNIFER MARIE DAVIS P.A.-C

MEDICARE: MRS. JENNIFER MARIE DAVIS P.A.-C
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
1363A00000XPhysician Assistant998AK

General Provider Information

NPI Number : 1306123005
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. JENNIFER MARIE DAVIS P.A.-C
Provider Business Mailing Address
First Line : 9220 LAKE OTIS PKWY STE 9
Second Line :
City : ANCHORAGE
State : AK
Zip : 99507-4249
Country : US
Telephone Number : 907-344-0200
Fax Number : 907-344-0214
Provider Business Practice Location Address
First Line : 9220 LAKE OTIS PKWY STE 9
Second Line :
City : ANCHORAGE
State : AK
Zip : 99507-4249
Country : US
Telephone Number : 907-344-0200
Fax Number : 907-344-0214
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/08/2011
Last Update Date : 11/08/2011

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