Provider Demographics
NPI:1104081702
Name:DAVIS, CHAD E (NP)
Entity type:Individual
Prefix:
First Name:CHAD
Middle Name:E
Last Name:DAVIS
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1098 S STATE ROAD 25
Mailing Address - Street 2:
Mailing Address - City:LOGANSPORT
Mailing Address - State:IN
Mailing Address - Zip Code:46947-6723
Mailing Address - Country:US
Mailing Address - Phone:574-722-4141
Mailing Address - Fax:574-735-3414
Practice Address - Street 1:1098 S STATE ROAD 25
Practice Address - Street 2:
Practice Address - City:LOGANSPORT
Practice Address - State:IN
Practice Address - Zip Code:46947-6723
Practice Address - Country:US
Practice Address - Phone:574-722-4141
Practice Address - Fax:574-735-3414
Is Sole Proprietor?:No
Enumeration Date:2008-07-23
Last Update Date:2008-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71002747A363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner