Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363L00000X | Nurse Practitioner | 21505905NP-PP | OR |
NPI | 1003282310 |
---|---|
Provider Name | Rachell Renee Davis |
First Address | Salem, OR 97302-2541 |
Second Address | Salem, OR 97302 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 20/08/2015 |
Last Update Date | 26/09/2017 |