Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RA0401X | Internist - Addiction Medicine | 013663 | LA |
NPI | 1336212729 |
---|---|
Provider Name | Anna Christine Davis |
First Address | Mandeville, LA 70470-0386 |
Second Address | Mandeville, LA 70471-7782 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 16/11/2006 |
Last Update Date | 01/10/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1185116 | (05) | LA |
B63266 | (02) | LA |