MEDICARE: DIANNE KATHLEEN DAVIS RNFA

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	163WR0006X	Registered Nurse First Assistant	569775	CA

General Provider Information

NPI Number	:	1972667798
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DIANNE KATHLEEN DAVIS RNFA

Provider Business Mailing Address
First Line	:	2345 QUAIL MEADOW DR
Second Line	:
City	:	MODESTO
State	:	CA
Zip	:	95355-9251
Country	:	US
Telephone Number	:	209-551-5828
Fax Number	:

Provider Business Practice Location Address
First Line	:	2345 QUAIL MEADOW DR
Second Line	:
City	:	MODESTO
State	:	CA
Zip	:	95355-9251
Country	:	US
Telephone Number	:	209-551-5828
Fax Number	:

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

Provider Enumeration Date	:	12/20/2006
Last Update Date	:	07/08/2007

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