Provider Demographics
NPI:1124173406
Name:DAVIS, ANIELA B (ANP)
Entity type:Individual
Prefix:MS
First Name:ANIELA
Middle Name:B
Last Name:DAVIS
Suffix:
Gender:F
Credentials:ANP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 143255
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99514-3255
Mailing Address - Country:US
Mailing Address - Phone:907-332-3231
Mailing Address - Fax:
Practice Address - Street 1:4241 B ST
Practice Address - Street 2:SUITE 301
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99503-5910
Practice Address - Country:US
Practice Address - Phone:907-351-1092
Practice Address - Fax:907-278-5944
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK12502163WP0808X
AK620363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health
Not Answered363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
AK620OtherAK STATE ANP LICENSE #