Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 363L00000X | Nurse Practitioner | 662538 | TX |
Y | 363LW0102X | Nurse Practitioner - Women's Health | 662538 | TX |
NPI | 1023033420 |
---|---|
Provider Name | Ms. Emma L Davis |
First Address | Dallas, TX 75204 |
Second Address | Dallas, TX 75204 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/07/2006 |
Last Update Date | 28/12/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
159358401 | (05) | TX |
159358402 | (05) | TX |
159358403 | (05) | TX |
159358404 | (05) | TX |
159358405 | (05) | TX |
8N4023 | BCBS (01) | TX |
P94377 | (02) |