Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207V00000X | Obstetrician & Gynecologist | 67111-20 | WI |
N | 207V00000X | Obstetrician & Gynecologist | MD00045314 | WA |
N | 207VF0040X | Female Pelvic Medicine and Reconstructive Surgeon | 67111-20 | WI |
NPI | 1538246152 |
---|---|
Provider Name | Debra Jean Davis |
First Address | Newark, DE 19713-4337 |
Second Address | Newark, DE 19713-4337 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 01/11/2006 |
Last Update Date | 21/01/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
H12825 | (02) | WA |