MEDICARE: NANCY ALICE DAVIDSON M.D.

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	207Q00000X	Family Medicine Physician	GO32795	CA

General Provider Information

NPI Number	:	1417959453
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NANCY ALICE DAVIDSON M.D.

Provider Business Mailing Address
First Line	:	6800 PALM AVE
Second Line	:	SUITE A
City	:	SEBASTOPOL
State	:	CA
Zip	:	95472-4269
Country	:	US
Telephone Number	:	707-823-5341
Fax Number	:	707-823-8638

Provider Business Practice Location Address
First Line	:	6800 PALM AVE
Second Line	:	SUITE A
City	:	SEBASTOPOL
State	:	CA
Zip	:	95472-4269
Country	:	US
Telephone Number	:	707-823-5341
Fax Number	:	707-823-8638

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

Provider Enumeration Date	:	08/10/2005
Last Update Date	:	01/02/2014

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