Provider Demographics
NPI:1154147890
Name:DAVIS, ELEANOR MARIE (APRN)
Entity type:Individual
Prefix:
First Name:ELEANOR
Middle Name:MARIE
Last Name:DAVIS
Suffix:
Gender:F
Credentials:APRN
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 8
Mailing Address - Street 2:
Mailing Address - City:UTOPIA
Mailing Address - State:TX
Mailing Address - Zip Code:78884-0008
Mailing Address - Country:US
Mailing Address - Phone:214-215-1616
Mailing Address - Fax:
Practice Address - Street 1:1120 E ELIZABETH ST STE 2
Practice Address - Street 2:
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80524-4044
Practice Address - Country:US
Practice Address - Phone:970-493-9193
Practice Address - Fax:970-639-4475
Is Sole Proprietor?:No
Enumeration Date:2024-11-26
Last Update Date:2025-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX764248207QA0401X
COC-APN.0103209-C-NP363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No207QA0401XAllopathic & Osteopathic PhysiciansFamily MedicineAddiction Medicine