Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LG0600X | Nurse Practitioner - Gerontology | AP60864438 | WA |
NPI | 1073006045 |
---|---|
Provider Name | Holly D Davis |
First Address | Kennewick, WA 99336-5600 |
Second Address | Kennewick, WA 99336-5600 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/06/2018 |
Last Update Date | 10/05/2021 |