MEDICARE: JUDY A. DAVIS APN,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		IL

General Provider Information

NPI Number	:	1558421719
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JUDY A. DAVIS APN,FNP

Provider Business Mailing Address
First Line	:	UIC COLLEGE OF NURSING PMA(MC802).
Second Line	:	845 S. DAMEN AVE SUITE 1058
City	:	CHICAGO
State	:	IL
Zip	:	60612-7350
Country	:	US
Telephone Number	:	773-996-5800
Fax Number	:	773-996-9049

Provider Business Practice Location Address
First Line	:	1110 W BELMONT AVENUE
Second Line	:	MOTHERS PROGRAMTHRESHOLDS
City	:	CHICAGO
State	:	IL
Zip	:	60657
Country	:	US
Telephone Number	:	773-472-3558
Fax Number	:

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

Provider Enumeration Date	:	12/11/2006
Last Update Date	:	07/08/2007

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