Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 363LP0808X | Nurse Practitioner - Psychiatric/Mental Health | AP60443726 | WA |
NPI | 1003223694 |
---|---|
Provider Name | Colleen Davenport |
First Address | Tacoma, WA 98409 |
Second Address | Baker City, OR 97814 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 16/07/2014 |
Last Update Date | 02/01/2020 |