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NPI Code Detail

MEDICARE: JAN WAYMENT DAVIS APRN

MEDICARE: JAN WAYMENT DAVIS APRN
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
1163WR0006XRegistered Nurse First Assistant206166-3102UT
2363LA2100XAcute Care Nurse Practitioner206166-4408UT

General Provider Information

NPI Number : 1821171786
Entity Type Code : Individual
Provider Name (Legal Business Name) : JAN WAYMENT DAVIS APRN
Provider Business Mailing Address
First Line : 5860 W 1400 N
Second Line :
City : OGDEN
State : UT
Zip : 84404-9023
Country : US
Telephone Number : 801-391-7506
Fax Number : 801-731-4652
Provider Business Practice Location Address
First Line : 5290 S 400 E
Second Line :
City : OGDEN
State : UT
Zip : 84405-7194
Country : US
Telephone Number : 801-476-1777
Fax Number : 801-479-1479
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/23/2006
Last Update Date : 01/14/2010

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