MEDICARE: MS. DENISE DAVIS MS RN NPC

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	041165350	IL

General Provider Information

NPI Number	:	1992793434
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. DENISE DAVIS MS RN NPC

Provider Business Mailing Address
First Line	:	901 CENTER ST
Second Line	:	SUITE 3000
City	:	ELGIN
State	:	IL
Zip	:	60120-2104
Country	:	US
Telephone Number	:	847-888-3661
Fax Number	:	847-888-9964

Provider Business Practice Location Address
First Line	:	901 CENTER ST
Second Line	:	SUITE 3000
City	:	ELGIN
State	:	IL
Zip	:	60120-2104
Country	:	US
Telephone Number	:	847-888-3661
Fax Number	:	847-888-9964

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

Provider Enumeration Date	:	10/10/2005
Last Update Date	:	10/24/2011

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