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NPI Code Detail

MEDICARE: WILLIAM STANTON DAVIS PMHNP-BC

MEDICARE: WILLIAM STANTON DAVIS PMHNP-BC
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
1363LP0808XPsychiatric/Mental Health Nurse Practitioner4704211030MI
2363L00000XNurse Practitioner4704211030MI
3163W00000XRegistered Nurse4704211030MI

General Provider Information

NPI Number : 1659581270
Entity Type Code : Individual
Provider Name (Legal Business Name) : WILLIAM STANTON DAVIS PMHNP-BC
Provider Business Mailing Address
First Line : 6549 TOWN CENTER DR STE A
Second Line :
City : CLARKSTON
State : MI
Zip : 48346-4824
Country : US
Telephone Number : 800-395-3223
Fax Number : 269-553-8012
Provider Business Practice Location Address
First Line : 8225 MOORSBRIDGE RD
Second Line :
City : PORTAGE
State : MI
Zip : 49024-7845
Country : US
Telephone Number : 800-395-3223
Fax Number : 248-620-6405
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/23/2007
Last Update Date : 11/14/2023

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