Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LA2200X | Nurse Practitioner - Adult Health | 224736 | AZ |
N | 363LP2300X | Nurse Practitioner - Primary Care | 4704272126 | MI |
NPI | 1013456201 |
---|---|
Provider Name | Tamika Davis |
First Address | Chicago, IL 60603-2420 |
Second Address | Farmington Hills, MI 48334-3390 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/02/2017 |
Last Update Date | 20/08/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
527474 | (05) | AZ |